Blunt Cardiac Injury

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.