Cardiac Trauma. Management Strategies short panoramic View.

Abstract

Introduction; Trauma is the leading cause of death in United States in the younger population. National Trauma Data Bank in 2017 reported that 140 000 Americans dies and 80 000 are permanently disabled as a result of trauma each year. Cardiac trauma is identified in less than 10% of all trauma admissions but is associated with a much higher mortality than other organ system injuries. Considering the lethality of this type of injury, better guidelines should exist to direct management. We have analyzed data from pub med, surgery books, reviews and original presentations from many institutions to present actuality in management strategies of cardiac injuries.
 Cardiac injuries are classified penetrating and blunt. Penetrating trauma includes stab or guns wounds. All patients with a penetrating wound anywhere near the heart should be considered to have a cardiac injury. The penetrating cardiac traumas is a surgical emergency while the blunt injuries treatment consists mainly in observation.
 With early aggressive management only 1/3 of patient that arrive at hospital can be saved and this number can arise to more than 70 % if the patient survives until operating room. The results of treatment depend from infrastructural health system to the clinical presentation of the patients. Penetrating cardiac wounds mortality varies 5 % to 76 %. Blunt cardiac injuries are encountered mostly during motor vehicle accidents. The incidence of cardiac injuries in blunt trauma is 2.3-4.6 %. Overall mortality varies 11.4-24.5 %. Myocardial contusion is the most frequent type of blunt cardiac injuries.
 The diagnose of the cardiac trauma include: clinical assessment, physical examinations, chest radiographs, echocardiography, cardiac enzymes, ECG, CT scan and even chest drainage. Despite many diagnostic tools we have, it is very important the right management of these tools and the time.
 Conclusion: The surgery teams should be familiar with the management of the cardiac injuries and continuing education about this topic is the success key to manage better these emergencies.