Cardiac Trauma
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 30 October 2016
⏱️ 10 minutes
🧾️ Download transcript
Summary
Cardiac tamponade. Aortic Dissection. Blunt cardiac injury.
Cardiac Tamponade
* Blood fills pericardial sac* Increasing pressure on myocardium -> Decreased preload* Decreased preload -> Hypotension -> Death* Clinical exam shows Beck’s Triad* Hypotension* Muffled heart sounds* Jugular venous distension (JVD)* Diagnosed during FAST exam (subxiphoid view)* Treat with pericardiocentesis* Bedside thoracotomy if patient loses pulse
Aortic Dissection/Rupture/Tear
* Common with rapid deceleration injuries* Most commonly occurs at ligamentum arteriosum* Small ligament that attaches arch of aorta to pulmonary artery* Remnant of the ductus arteriosus* Obtain CTA of the chest if…* Widened mediastinum on chest x-ray* Unequal pulses* Concerning mechanism of injury* Requires emergent repair
Blunt Cardiac Injury
* Contusion to the myocardium can cause arrhythmia/death* Place patient on cardiac monitor* Consider EKG/troponin* Commotio Cordis* Blunt impact to chest resulting in ventricular fibrillation
Additional Reading
* Blunt Cardiac Injury (American Association for the Surgery of Trauma)* FAST Exam (SAEM)
Transcript
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| 0:00.0 | Hello, med students. My name is Zach Olson, and thank you for downloading this week's |
| 0:06.2 | episode of the EM Clerkship Podcast. Today we will be continuing our trauma series. A few weeks ago, |
| 0:15.8 | we discussed lung and chest wall injuries. This week, we will be staying above the diaphragm and discussing |
| 0:23.7 | cardiovascular trauma. Hey, Doc, so we have a 47-year-old female. She's a driver in a vehicle |
| 0:34.4 | versus guardrail. Found unconscious with rapid labor breathing at the scene |
| 0:38.9 | NPA was placed. Bagging got us 96% on O2. Looks like she bent the steering wheel in half with her chest, |
| 0:47.6 | discoloration and instability noted to the anterior chest bilateral femo fractures. Ultrasound showed free fluid |
| 0:53.6 | in the abdomen as well, |
| 0:54.9 | so you guys know, facial lax. BP was 94 over 65 minutes ago. We were giving 200 millilit |
| 1:01.4 | boluses just to maintain. That's what she's gotten 400 milliliters total. Pulse is 140, |
| 1:06.0 | respirations of 36. EKG was all over the place. You could look at that. Some of that might actually be some artifact, but there you go. |
| 1:14.9 | Yep. |
| 1:15.7 | Any questions? |
| 1:16.6 | Anybody? |
| 1:16.7 | In this episode, there are three major diagnoses that I want you to know. |
| 1:25.5 | Cardiac Tampanod, aortic dissection, and blunt cardiac injury, previously known as cardiac contusion. |
| 1:35.3 | Those are the big three. |
| 1:37.2 | And since the workup for each of these is completely different and the treatments are different, |
| 1:41.9 | in this episode we will go through each one individually, |
| 1:45.3 | almost like three mini-critical diagnosis episodes. |
| 1:50.3 | First, cardiac tamponad. This is most commonly seen with penetrating chest trauma, but it can |
| 1:57.7 | also happen with blunt trauma. The heart itself is surrounded by a tough, fibrous sac called the paracardium. |
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