Updated: 12/21/2019

Blunt Cardiac Injury

0%
Topic
Review Topic
0
0
0%
0%
Questions
1 1
0
0
Snapshot
  • A 30-year-old man presents after a motor vehicle collision to the emergency room. Although he is conscious and responsive, he reports severe chest pain. His blood pressure is 83/55 mmHg, pulse is 120/min, and respirations are 24/min. On physical exam, he has extensive ecchymosis over his anterior chest wall. He has jugular venous distention and muffled heart sounds. An electrocardiogram reveals diffused ST elevations and sinus tachycardia. A focused assessment with sonography in trauma (FAST) exam reveals pericardial fluid.
Introduction
  • Clinical definition
    • trauma to the thoracic cage, resulting in cardiac injury
  • Epidemiology
    • location
      • right ventricle is most commonly injured
        • it is right below the sternum
      • aortic valve is the most common valve to be injured
    • risk factors
      • motor vehicle collisions
      • crush injuries
  • Etiology
    • myocardial contusion
    • arrhythmias
    • injury to valves or vessels
    • cardiac rupture
    • sudden cardiac arrest from sternal blow
  • Pathogenesis
    • blunt cardiac trauma, such as myocardial contusion, disrupts normal heart function, causing pump failure or tamponade
  • Associated conditions
    • head trauma
  • Prognosis
    • survival depends on etiology of blunt cardiac trauma
      • patients with frank cardiac rupture often do not even make it to the emergency room
Presentation
  • Symptoms
    • chest pain
    • difficulty breathing
    • palpitations
    • lightheadedness
  • Physical exam
    • physical exam findings depend on etiology
    • patients may be in shock
      • hypotension
    • anterior chest wall
      • ecchymosis
      • tenderness to palpation
      • step-off indicating rib or sternal fracture
      • subcutaneous crepitus
        • likely has pneumothorax as well
    • new heart murmur
    • jugular venous distention
Imaging
  • Focused assessment with sonography in trauma (FAST) exam
    • indication
      • for all patients with trauma
    • findings
      • cardiac motion abnormalities
      • pericardial blood
      • free fluid in peritoneum
  • Chest radiography
    • indication
      • if rib fracture is suspected
    • findings
      • rib fracture
      • pneumopericardium
  • Echocardiography
    • indication
      • for all patients
    • findings
      • detect structural abnormalities
      • detect pericardial effusion or tamponade
Studies
  • Labs
    • cardiac enzyme troponin-I
      • 93-94% negative predictive value
  • Electrocardiogram (ECG)
    • indication
      • best initial test
    • findings
      • sinus tachycardia
      • arrhythmias
      • conduction abnormalities (e.g., bundle branch blocks)
      • prolonged QT intervals
      • ST segment changes
  • Making the diagnosis
    • based on clinical presentation, ECG, and imaging
Differential
  • Myocardial infarction-induced cardiogenic shock
    • distinguishing factor
      • no evidence of external trauma
Treatment
  • Management approach
    • treat with Advanced Trauma Life Support protocol
    • treat underlying cause of blunt cardiac trauma
  • Medical
    • intravenous fluid resuscitation
      • indication
        • patients with hypotension
    • amiodarone
      • indication
        • patients with ventricular dysrhythmias
  • Operative
    • pericardiocentesis or pericardial window
      • indication
        • patients with pericardial tamponade
Complications
  • Heart failure
  • Emboli
  • Cardiopulmonary arrest
 

Please rate topic.

Average 4.0 of 3 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (1)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
Calculator

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Topic COMMENTS (2)
Private Note