This is the EM cases, EM quick hits podcast, where our team of experts and educators bring

you clear, concise, and condensed, practice-changing knowledge on all those EM

topics that you may not be totally comfortable with. Cases, the latest evidence, procedural tips

and tricks, pitfalls to avoid, and the key take-home points and references on the EM cases

website. Quick, let's get on with it. First up, we've got Petro on diagnosis and wrist

stratification in blunt cardiac trauma, a truly nebulous diagnosis.

On a recent trauma call, I was asked by a resident whether we should consider a blunt cardiac injury in a patient that we had.

A patient had admittedly displaced sternal fracture following an MVC.

They were hemidamically stable and they had some other

orthopedic injuries, but they were otherwise fine. It got me thinking as this is a diagnosis that we

occasionally consider yet really don't have great evidence to guide our approach. The resident

and I discussed the case and we ended up doing an ECG, which was normal, but the troponin came back positive. According to the

most recent guidelines, which were published way back in 2012 by East, or the Eastern Association for

the Surgery of Trauma, yes, that's the most recent ones we have. They state that a normal ECG and a

negative terponin effectively rule out blunt cardiac injury, but this patient had

a positive trope.

Three times our upper limit of normal.

So now what?

Keeping that case in mind, I want to focus on three questions.

What are blunt cardiac injuries anyways?

How do we diagnose them and should troponins be part of the evaluation? And do sternal fractures

even matter? Starting with the first question, what are blunt cardiac injuries? The short answer is we

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