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Blunt Cardiac Injury

  • Nathan R. Manley
  • George O. MaishIIIEmail author
Chapter

Abstract

Blunt cardiac injury (BCI) should be considered in any patient with history of anterior chest wall trauma (e.g., broken steering column). Work-up includes routine trauma labs, chest x-ray, echocardiogram (EKG), troponins, and detailed past medical history. Specific management will depend on results of EKG and troponins and whether the patient is hemodynamically stable or unstable. If troponins and EKG are normal, BCI can be ruled out, and continued trauma work-up should be guided by chief complaint and other injuries. Any patient with abnormal EKG or troponin should be evaluated by cardiology and admitted for observation on continuous telemetry, and an echocardiogram should be considered. In hemodynamically unstable patients, initial management should be guided by advanced trauma life support (ATLS) and advanced cardiac life support (ACLS) protocols. Cardiology should be consulted and echocardiogram should be performed. If any structural defect is found, cardiothoracic surgery should be consulted immediately for possible operative repair. Placement of a pulmonary artery catheter may be considered to guide fluid resuscitation. Finally, it is important to maintain a high degree of suspicion for underlying cardiac disease and myocardial infarction in any patient presenting with blunt trauma.

Keywords

Advanced cardiac life support (ACLS) Advanced trauma life support (ATLS) Blunt cardiac injury Cardiac arrhythmia Cardiogenic shock Echocardiogram Electrocardiogram (EKG) Myocardial infarction Pulmonary artery catheter Telemetry Troponin 

Suggested Reading

  1. American College of Surgeons. Advanced trauma life support. 9th ed. Chicago: American College of Surgeons; 2012. 336 p.Google Scholar
  2. American Heart Association. Advanced cardiac life Support. Dallas: American Heart Association; 2015. 183 p.Google Scholar
  3. Clancy K, Velopulos C, Bilaniuk JW, Collier B, Crowley W, Kurek S, et al. Screening for blunt cardiac injury: An Eastern Association for the Surgery of Trauma practice management guide. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S301–6.CrossRefGoogle Scholar
  4. Legome E, Kadish H. Cardiac injury from blunt trauma. Up to Date [Internet]. 2017 Jul [cited 2017 Aug 13]. Available from: http://www.uptodate.com/contents/cardiac-injury-from-blunt-trauma.

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Tennessee Health Science CenterMemphisUSA

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