Cardiac contusion: Difference between revisions

Revision as of 04:04, 25 July 2015

Background

Cardiac contusion is on the spectrum of Blunt cardiac injury (BCI), which ranges from mild contusion to cardiac rupture.^[1]
- Contusion is the most common of these, found in 60-100% of all blunt cardiac injury. (Other sources cite lower figures of 8-76%^[2])
- Range is due to lack of standardized diagnostic criteria.
Mechanism of injury
- MVC is common, but crush injuries, CPR and others have also been described.
- Can occur with decelerations from as little as less than 20mph^[2]
Autopsy shows patchy necrosis and hemorrhage of damaged areas of myocardium.

Clinical Features

Chest pain
Palpitations
Tachycardia
Dyspnea/SOB

Differential Diagnosis

Thoracic Trauma

Airway/Pulmonary
Cardiac/Vascular
- Cardiac injury
- Traumatic aortic transection
Musculoskeletal
Other

Diagnosis

Physical
- New murmur
EKG
- most common abnormality in order
  - Sinus tachy
  - PVCs
  - A. fib
- Dysrythmia can be delayed for up to 12 hours
Do NOT need enzymes but can help dx
- Positive Trop
Echo
- Can aid in further determining the extent of damage

Treatment

Treat arrhythmia prn
- Do NOT treat prophylactically (increased mortality!)
NO thrombolytics for AMI (increased mortality)

Disposition

Observation for 6 hours

Admit to telemetry bed for:
- Abnormal physical exam
- Abnormal EKG
- Hypotension

References

↑ El-Menyar A, Al Thani H, Zarour A, Latifi R. Understanding traumatic blunt cardiac injury. Ann Card Anaesth. 2012 Oct-Dec;15(4):287-95. doi: 10.4103/0971-9784.101875.
↑ ^2.0 ^2.1 El-Chami MF, Nicholson W, Helmy T. Blunt cardiac trauma. J Emerg Med. 2008 Aug;35(2):127-33.

Authors:

[El-Menyar-1] El-Menyar A, Al Thani H, Zarour A, Latifi R. Understanding traumatic blunt cardiac injury. Ann Card Anaesth. 2012 Oct-Dec;15(4):287-95. doi: 10.4103/0971-9784.101875.

[El-Chami-2] 2.0 ^2.1 El-Chami MF, Nicholson W, Helmy T. Blunt cardiac trauma. J Emerg Med. 2008 Aug;35(2):127-33.

[1]

[2]

@@ Line 1: / Line 1: @@
 ==Background==
-*MVC with chest striking the steering wheel
+*Cardiac contusion is on the spectrum of [[Blunt cardiac injury]] (BCI), which ranges from mild contusion to cardiac rupture.<ref name="El-Menyar">El-Menyar A, Al Thani H, Zarour A, Latifi R. Understanding traumatic blunt cardiac injury. Ann Card Anaesth. 2012 Oct-Dec;15(4):287-95. doi: 10.4103/0971-9784.101875.</ref>
+**Contusion is the most common of these, found in 60-100% of all blunt cardiac injury. (Other sources cite lower figures of 8-76%<ref name="El-Chami">El-Chami MF, Nicholson W, Helmy T. Blunt cardiac trauma. J Emerg Med. 2008 Aug;35(2):127-33.</ref>)
+**Range is due to lack of standardized diagnostic criteria.
+*Mechanism of injury
+**MVC is common, but crush injuries, CPR and others have also been described.
+**Can occur with decelerations from as little as less than 20mph<ref name="El-Chami" />
+*Autopsy shows patchy necrosis and hemorrhage of damaged areas of myocardium.
 ==Clinical Features==
 *Chest pain
 *Palpitations
-*Tachy
+*Tachycardia
 *Dyspnea/SOB
@@ Line 26: / Line 32: @@
 ==Treatment==
-#Treat arrhythmia prn
+*Treat arrhythmia prn
-#*Do NOT treat prophylacticly (increased mortality!)
+**Do NOT treat prophylactically (increased mortality!)
-#NO thrombolitics for AMI here (increased mortality)
+*NO thrombolytics for AMI (increased mortality)
-severity depends on underlying CAD because of inflammatory changes= redistribute coronary flow that may= ischemic cp.
 ==Disposition==
 Observation for 6 hours
-===Admit for (telemetry bed):===
+*Admit to telemetry bed for:
-*Abnormal physical
+**Abnormal physical exam
-*Abnormal [[EKG]]
+**Abnormal [[EKG]]
-*Hypotension
+**Hypotension
 ==See Also==