Blunt Thoracic Trauma

Adapted from Kristin Schreiber's Grand Rounds presentation, October 18th, 2016

Blunt Cardiac Injury

Any traumatic injury which effects the heart's ability to function. Normally diagnosed via EKG and blood monitoring. Commonly caused by direct trauma to the chest, including MVC, pedestrians, and crush injuries. Injuries can range from pericardial injury or cardiac rupture, to mild troponin elevations and sinus tachycardia. 

Patients at risk for cardiac injury

• Seatbelt sign
• Ecchymosis or tenderness to the chest wall 
• Sternal fractures or rib fractures
• Subcutaneous air
• Severe mechanism of injury

Treatment Guidelines

East Trauma Guidelines, 2012
Level 1 Guidelines: 

• Obtain an EKG for any patient suspected of BCI

Level 2 Guidelines:

• Admission for any new EKG changes other than sinus tachycardia
• Elevated troponins, regardless of EKG, should be admitted for monitoring
• Normal EKGs with normal troponins can be ruled out for BCI, even in patients with sternal fractures
• Any admission with BCI should have an echocardiogram prior to discharge
• East Trauma Guidlines recommended against CK utilization

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Higher mortality is noted in patients who are hypotensive on presentation, lactate >2.5, co-morbid hemothorax, or elevated troponins. 

Commotio Cordis

Blunt force trauma to the pericordium during the t-wave, causing a fine ventricular fibrillation

Disposition

Patients without other injuries, who are hemodynamically stable with isolated abnormal EKGs or elevated troponins should be admitted for 24-48 hours.