DOCSLIB.ORG

Understanding Traumatic Blunt Cardiac Injury

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Understanding Traumatic Blunt Cardiac Injury Review Article Understanding traumatic blunt cardiac injury Ayman El-Menyar1,2, Hassan Al Thani1, Ahmad Zarour1, Rifat Latifi1,2 1Department of Surgery, Section of Trauma Surgery, Hamad Medical Corporation, 2Clinical Medicine, Weill Cornell Medical School, Qatar ABSTRACT Cardiac injuries are classified as blunt and penetrating injuries. In both the injuries, the major issue is missing the diagnosis and high mortality. Blunt cardiac injuries (BCI) are much more common than penetrating injuries. Aiming at a better understanding of BCI, we searched the literature from January 1847 to January 2012 by using MEDLINE and EMBASE search engines. Using the key word “Blunt Cardiac Injury,” we found 1814 articles; out of which 716 articles were relevant. Herein, we review the causes, diagnosis, and management of BCI. In conclusion, traumatic cardiac injury is a major challenge in critical trauma care, but the guidelines are lacking. A high index of suspicion, application of current diagnostic protocols, and prompt and appropriate management is mandatory. Received: 17-3-2012 Accepted: 29-6-2012 Key words: Blunt trauma, Blunt cardiac injury, Aortic injury INTRODUCTION echocardiographic analysis, 24 prospective studies, 20 retrospective studies, and 1 Cardiac injuries are classified as blunt meta-analysis. Herein, we review the causes, and penetrating injuries. In both the type diagnosis, and management of BCI. of injuries, the major issue is missing the diagnosis and high mortality. Blunt cardiac BLUNT CARDIAC INJURY injuries (BCIs) are much more common than penetrating injuries. Penetrating trauma is seen BCI ranges from asymptomatic myocardial in urban trauma centers and predominantly bruise to cardiac rupture and death.[2-4] BCIs due to stab wounds, gunshot wounds, or less most often occur during motor vehicle crashes commonly other iatrogenic instrumentation. (MVC). Based on the associated injuries, In penetrating injuries, up to 90% of victims intensity of chest injury, and complexity of die before reaching hospital and resuscitation injuries the incidence of BCI varies from is of limited benefit; therefore, survival 20 to 76%. Falls and crush injuries are less depends on rapid pre-hospital transport.[1] frequently associated with BCI. BCIs are characterized by patchy areas of muscle Access this article online Aiming at better understanding of BCI, we necrosis and hemorrhagic infiltrate(s), rupture Website: www.annals.in reviewed the literature from January 1847 of small vessels, and hemorrhage into the PMID: to January 2012 by utilizing MEDLINE interstitium and around the muscle fibers.[4] *** and EMBASE search engines. Using the Myocardial contusion has been reported in DOI: 10.4103/0971-9784.101875 key word “Blunt Cardiac Injury,” we found 60–100% autopsy series of patients with BCI.[3] Quick Response Code: 1814 articles; out of which 716 articles were relevant. Of the relevant articles, 559 were Commotio Cordis published in English language; there were 100 Commotio Cordis is a rare type of BCI in reviews, 135 case reports (some case reports which low-impact chest trauma causes sudden were followed by review of the literature), 22 cardiac arrest, usually occurs from being struck pediatric-related articles, 35 articles based on by a projectile during sports. Cardiac arrest Address for correspondence: Dr. Ayman El-Menyar, Weill Cornell Medical School, Clinical Medicine, Cardiologist and Clinical Research, Trauma Surgery, Hamad General Hospital, PO Box 3050, Doha, Qatar. E-mail: [email protected] Annals of Cardiac Anaesthesia Vol. 15:4 Oct-Dec-2012 287 El-Menyar, et al.: Traumatic blunt cardiac injury appears to stem from blow during a period of electrical Table 1: Summary of the mechanism of BCI vulnerability (10 to 30 ms before the peak of the T Direct impact Commtio cordis wave). A direct blow to the precordium accounts for a Myocardial contusion sizable number of cases. Patients involved in a MVC Rapid deceleration Aortic tear, Cardiac rupture with sudden deceleration, or who sustains significant Rapid deceleration or Compression Ruptured myocardium chest trauma or severe multiple trauma are at risk of Commotio Cordis.[5] and aortic valve insufficiency, respectively. [4] Other less common pathological findings in patients with Cardiac Rupture BCI include septal tears (Atrial septal defect: 7% Between 1847 and 1952, 13 cases of rupture of Ventricular septal defect : 4%) Coronary artery injury interventricular septum due to BCI were described. [6] and thrombosis (3%).[3] The mechanism of injury and factors necessary to produce rupture of the heart after blunt injury were Indirect cardiac injury reported between 1935 and 1938. A full chamber in early Even if the heart is not directly involved in the trauma, systole is more vulnerable if compressed over its outflow cardiac injury remains a possible concern. The stressful tract; the myocardial fibers may rupture at a point away impact of trauma may result in myocardial infarction from the area of direct contusion.[6] Between 1994 and secondary to acute thrombosis or severe coronary 2009, several other mechanisms of blunt traumatic spasm (with patent coronary arteries). Also, significant cardiac rupture have been reported, and include arrhythmia and stress-induced cardiomyopathy precordial impaction with cardiac squeeze between the (Takotsubo cardiomyopathy) have been reported in many sternum and spine and rapid deceleration resulting in cases secondary to the fear and stress of trauma. [13,14] disruption of the atria from their connections to the vena cava and pulmonary veins.[7,8] Minimal force is required Blunt aortic injury for a deceleration type contusion injury that may occur Blunt aortic injury (BAI) is a common cause of traumatic at a relatively low velocity of 20 miles/h.[9,10] pericardial tamponade. It should be considered in patients with a deceleration or acceleration injury with Cardiac rupture is the most devastating BCI and the signs suggestive of mediastinal injury. [15] BAI is the incidence of the site of injury varies in various autopsy second most common cause of death in blunt trauma series (Cardiac wall: 0.16–2%, Right ventricle: 19–32%, patients.[16] Most patients with BAI die at the place of Right atrium: 10–15%, Left ventricle: 5–44%, and Left injury, and only 13–15% reach alive to hospitals.[16,17] atrium: 1–7%).[3,11] The most common mechanism of BAI is motor vehicle crash, pedestrian injury, and falls.[15,18] Forces involved in BCI Include compression of the heart between the spine and Cardiac herniation sternum, abrupt pressure fluctuations in the chest and It is a potentially fatal complication of BCI and abdomen, shearing from rapid deceleration and blast reported in 0.4% of severe blunt trauma. [19,20] Cardiac injury, and fragments from rib fractures causing injury herniation frequently results in early death, and thus to the heart. Table 1 summarizes the mechanism of BCI. the diagnosis is mainly based on autopsy findings.[20] In a series of BCI, patients who survived to hospital The right heart is most commonly injured.[12] This is probably due to its position closest to the anterior chest admission had favorable outcome with survival rate of [21] wall. High-pressure ventricular injuries appear to be as 36.4-42.9%. The high in-hospital mortality rate (up common as low-pressure atrial injuries, but findings to 64%) is probably a reflection of not only pericardial may vary based on the type of study (i.e. clinical or rupture and cardiac herniation but also of the associated autopsy). In autopsy series, ventricular injuries are the injuries.[19,22] dominant findings. Aortic and mitral valve damage has been reported as a complication of blunt chest injury. [4] Pericardial effusion The incidence of tricuspid or mitral valvular injury is Definite diagnosis of traumatic pericardial effusions is around 5% which include chordal rupture, anterior not easy even with Focused Assessment with Sonography papillary muscle and/ or leaflet tear.[3,4] Ismailov et al. for Trauma (FAST), repeat cardiac echocardiography, reported that BCI is independently associated with and computed tomography (CT). [23] Patients who survive 11 and 3 times increase in the incidences of tricuspid to the hospital usually have minor tears in the low- 288 Annals of Cardiac Anaesthesia Vol. 15:4 Oct-Dec-2012 El-Menyar, et al.: Traumatic blunt cardiac injury pressure chamber with a blood clot that temporarily significant BCI are usually present at the time of stops the bleeding or have decompression of blood admission or occasionally within 24 h. [3,34] However, into the pleural cavity because of a pleuropericardial it can be difficult to determine whether the ECG defect.[23] Compared with penetrating chest injuries, abnormality is a primary event (e.g. an acute coronary cardiac injury is more easily neglected in blunt trauma, syndrome (ACS) that preceded trauma), a direct especially when associated with head or abdominal result of cardiac injury, or a problem brought on by injury.[23,24] Huang et al. reported that 87.1% of traumatic the physiologic stress of severe trauma.[2,34] Several pericardial effusions were due to blunt trauma and studies concluded that in hemodynamically stable 51.7% were associated with cardiac injury or rupture.[23] young patients, normal ECG rules out the need for further evaluation to detect BCI. [3,35] Patients with Associated injuries unexplained tachycardia that persists over several In BCI, the most common associated injuries are: hours despite adequate fluid resuscitation and pain rib fractures (18–69%), lung contusion (6–58%), flail control, or with a new bundle branch block, or with chest (3–38%), sternal fracture (0–60%), head injury significant arrhythmia, should be admitted for rhythm (20–73%), and abdominal solid organ injury (5–43%).[3] monitoring and possible echocardiographic study. Life- threatening ventricular arrhythmias were reported in Delayed complications up to 16% of patients with BCI.[4] A 24 h monitoring Pericardial, myocardial or valvular injuries may present with ECG telemetry is required if a patient suspected of late after trauma.
Load more

Recommended publications
  • Blunt Thoracic Trauma
    CARDIOTHORACIC SURGERY II standard ATLSÔ principles, starting with control of the Airway. Blunt thoracic trauma While it is obvious that a chest injury may affect Breathing, the major effect of a tension pneumothorax and haemothorax is on Nathan Burnside Circulation. A chest drain will be both diagnostic and therapeutic. Kieran McManus Unlike penetrating injuries, most blunt chest injuries do not need immediate resuscitative surgery, but it is wrong to assume that they do not require surgical intervention at all. This presumption can Abstract result in the potential benefit of a specialist thoracic opinion being The restructuring of emergency healthcare services has led to more blunt ignored, and many injuries being undertreated. thoracic trauma being treated by a multidisciplinary team, including gen- eral, orthopaedic and trauma surgeons, often without immediate access Secondary survey to a thoracic surgeon. Having a critical mass of injured patients in a cen- tral location, it has been possible to bring expertise from other areas of When assessing chest injuries, the mechanism of trauma (Table 1) intensive care, radiology and surgery and apply new technology and tech- may be more relevant in terms of immediate injury and eventual niques to the trauma patient. We now see the regular use of endovascular outcome than the radiological images. The details of the accident stenting and embolization reducing the need for urgent surgery on unsta- are key to establishing the specific injuries that arise in connection ble patients and the increasing use of extracorporeal membranous with particular trauma situations and can often predict the late oxygenation (ECMO) to salvage patients with acute respiratory distress sequelae (Table 2).
    [Show full text]
  • Cardiac Concussion (Commotio Cordis)
    PEDIATRIC EM • PÉDIATRIE D’URGENCE Cardiac concussion (commotio cordis) Rahim Valani, MD;* Angelo Mikrogianakis, MD;† Ran D. Goldman, MD† SEE ALSO COMMENTARY, PAGE 431. ABSTRACT Blunt chest trauma in pediatric patients can result in various injuries to the myocardium. Cardiac concussion (commotio cordis) is seen in patients in whom the precordium has been struck with rel- atively little force at a vulnerable period of the cardiac cycle. These patients have no predisposing cardiac problems, and autopsy reveals no evidence of heart damage. The usual clinical presenta- tion is that of immediate collapse secondary to a lethal arrhythmia. Prevention is the cornerstone of potentially decreasing the incidence with the aid of safety equipment and, possibly, immediate defibrillation. Key words: commotio cordis; chest trauma, pediatric; defibrillation; resuscitation RÉSUMÉ Un traumatisme contondant au thorax chez les patients pédiatriques peut causer diverses lésions au myocarde. On constate une commotion cardiaque (commotio cordis) chez les patients dont la région précordiale a subi un choc relativement faible à un moment vulnérable du cycle cardiaque. Ces patients n’ont aucun problème cardiaque prédisposant et l’autopsie ne révèle aucun signe de dommages cardiaques. Sur le plan clinique, le phénomène se manifeste habituellement par un ef- fondrement immédiat secondaire à une arythmie mortelle. La prévention constitue la pierre an- gulaire de la réduction possible de l’incidence au moyen de matériel de sécurité, et peut-être, d’une défibrillation immédiate. Introduction heart damage, even at autopsy.3,4 Emergency physicians, particularly those interested in injury prevention, should be Although trauma, in general, is the leading cause of mor- familiar with cardiac concussion because its mortality rate tality in children worldwide1,2 clinically significant isolated is as high as 85% and because it is often preventable.5 blunt chest trauma in children is rare.
    [Show full text]
  • Cardiac Emergencies: Blunt Chest Trauma George Karatasakis, MD, FESC Onassis Cardiac Surgery Center, Athens, Greece
    1955 Srce i krvni sudovi 2013; 32(3): 192-194 Pregledni rad UKS CSS UDRUŽENJE KARDIOLOGA SRBIJE CardiologY SOCIETY OF SERBIA Cardiac emergencies: Blunt chest trauma George Karatasakis, MD, FESC Onassis Cardiac Surgery Center, Athens, Greece Abstract Blunt chest trauma is considered a major health problem worldwide because of the tremendous incre- ase of the motor vehicle accidents. Any part of the heart or the great vessels can be injured. Hemope- ricardium and myocardial contusion are the most frequent cardiac lesions in patients who survive a motor vehicle accident. Rupture of a cardiac chamber, the aorta, or the coronary arteries is often fatal. Valve ruptures especially of the tricuspid valve carry a better prognosis. Diagnosis is based on troponin and cardiac enzymes measurement, ECG changes, chest X-ray, echocardiography and spiral computed tomography. Management of patients with compromised hemodynamics and progressive deteriora- tion is surgical often on an emergent basis. Key words blunt chest trauma, heart and great vessel injury hest injury may affect any organ situated in the tho- thermore, thoracic aorta damage is involved in 15% of racic cavity including the heart and great vessels. patients dying because of motor vehicle accidents2. This CBlunt mechanisms are more often involved in chest discrepancy, between clinical and autopsy findings, may wounds while penetrating traumas are less frequent. lead to the conclusion that the majority of severe injuries Injuries of the skeletal components of the chest (pec- of the heart and great vessels remain undiagnosed with toral muscles, ribs, clavicles etc.) have a better prognosis, lethal consequences. Rupture of a cardiac chamber, is provided that the broken bones do not penetrate any vi- encountered in 35-65% of autopsies, of patients dying tal organ.
    [Show full text]
  • ACR Appropriateness Criteria: Blunt Chest Trauma-Suspected Cardiac Injury
    Revised 2020 American College of Radiology ACR Appropriateness Criteria® Blunt Chest Trauma-Suspected Cardiac Injury Variant 1: Suspected cardiac injury following blunt trauma, hemodynamically stable patient. Procedure Appropriateness Category Relative Radiation Level US echocardiography transthoracic resting Usually Appropriate O Radiography chest Usually Appropriate ☢ CT chest with IV contrast Usually Appropriate ☢☢☢ CT chest without and with IV contrast Usually Appropriate ☢☢☢ CTA chest with IV contrast Usually Appropriate ☢☢☢ CTA chest without and with IV contrast Usually Appropriate ☢☢☢ US echocardiography transesophageal May Be Appropriate O CT chest without IV contrast May Be Appropriate ☢☢☢ CT heart function and morphology with May Be Appropriate IV contrast ☢☢☢☢ US echocardiography transthoracic stress Usually Not Appropriate O MRI heart function and morphology without Usually Not Appropriate and with IV contrast O MRI heart function and morphology without Usually Not Appropriate IV contrast O MRI heart with function and inotropic stress Usually Not Appropriate without and with IV contrast O MRI heart with function and inotropic stress Usually Not Appropriate without IV contrast O MRI heart with function and vasodilator stress Usually Not Appropriate perfusion without and with IV contrast O CTA coronary arteries with IV contrast Usually Not Appropriate ☢☢☢ SPECT/CT MPI rest only Usually Not Appropriate ☢☢☢ FDG-PET/CT heart Usually Not Appropriate ☢☢☢☢ SPECT/CT MPI rest and stress Usually Not Appropriate ☢☢☢☢ ACR Appropriateness
    [Show full text]
  • Mechanically Induced Sudden Death in Chest Wall Impact (Commotio Cordis) Mark S
    Progress in Biophysics & Molecular Biology 82 (2003) 175–186 Review Mechanically induced sudden death in chest wall impact (commotio cordis) Mark S. Link* From the Cardiac Arrhythmia Service, New England Medical Center, Tufts University School of Medicine, Boston, MA, USA Abstract Sudden death due to nonpenetrating chest wall impact in the absence of injury to the ribs, sternum and heart is known as commotio cordis. Although once thought rare, an increasing number of these events have been reported. Indeed, a significant percentage of deaths on the athletic field are due to chest wall impact. Commotio cordis is most frequently observed in young individuals (age 4–18 years), but may also occur in adults. Sudden death is instantaneous or preceded by several seconds of lightheadedness after the chest wall blow. Victims are most often found in ventricular fibrillation, and successful resuscitation is more difficult than expected given the young age, excellent health of the victims, and the absence of structural heart disease. Autopsy examination is notable for the lack of any significant cardiac or thoracic abnormalities. In an experimental model of commotio cordis utilizing anesthetized juvenile swine, ventricular fibrillation can be produced by a 30 mph baseball strike if the strike occurred during the vulnerable period of repolarization, on the upslope of the T-wave. Energy of the impact object was also found to be a critical variable with 40 mph baseballs more likely to cause ventricular fibrillation than velocities less or greater than 40 mph. In addition, more rigid impact objects and blows directly over the center of the chest were more likely to cause ventricular fibrillation.
    [Show full text]
  • Chapter : Chest Trauma 5 Contact Hours
    Chapter : Chest Trauma 5 Contact Hours Author: Jassin M. Jouri Jr., MD Learning objectives Describe the common etiology of chest trauma. Describe diagnosis strategies for blunt chest injuries. Explain the pathophysiology of chest trauma. Identify common treatments for blunt chest injuries. List common injuries to the chest wall. Explain common treatment strategies for penetrating chest injuries. Identify common types of pulmonary and pleural space injuries. Describe recovery procedures for chest injuries. Recognize the impact of chest trauma on the tracheobronchial Identify the most common cause of penetrating chest injuries. region. Explain pain management strategies for chest injuries. Define common types of cardiac injury. Describe the purpose of intubation and ventilation in patients with Identify the two categories of chest injury. cardiac injury. Recognize the visual signs of a blunt chest injury. Introduction Chest trauma is ranked 3rd highest cause of morbidity and mortality positive pressure imposed on the chest wall. [13] These are typically in the USA after head and extremity trauma. [2] An accident or caused by accidents and fall injury. Blunt injury can affect all the areas premeditated penetration of a foreign object into the chest is the usual of the chest wall, thoracic cage and its contents. These components cause of chest trauma or injury. This type of injury may further result may range from the bony structures like ribs, clavicles, scapulae, and in bruises, fracture of ribs or severe injury to the chest wall such as sternum and viscera like lungs and pleurae, trachea-bronchial tree, lung or heart contusions. Furthermore, major chest trauma may occur esophagus, heart, great vascular structures, and the diaphragm.
    [Show full text]
  • NATA Official Statement on Commotio Cordis According to the U.S
    NATA Official Statement on Commotio Cordis According to the U.S. Commotio Cordis Registry, since 1995, 188 athletes have died from blunt force injury to the heart (commotio cordis). Of those 188 fatalities, the mean age was 14.7 years and 96% were male athletes according to the Heart Center at TUFTS New England Medical Center. In an effort to educate the public about the potential risks physically active youth can face, the National Athletic Trainers’ Association (NATA) recommends that parents and coaches take proactive steps to protect their athletes against commotio cordis. Commotio cordis is caused by a blow to the chest (directly over the left ventricle of the heart) that occurs at a certain point of a person’s heart beat. The blunt force causes a lethal abnormal heart rhythm called ventricular fibrillation. The force of the blow to the chest is common at speeds of 35-40 mph. The following suggestions can help prevent commotio cordis and keep young athletes safe: 1. Educate coaches, parents, officials, and players in the recognition of the mechanism and the signs and symptoms of commotio cordis. 2. Encourage all coaches and officials to become trained in cardiopulmonary resuscitation (CPR), automatic external defibrillator (AED) use, and first aid. 3. Proper placement and access of automatic external defibrillator (AED) units at athletic facilities. 4. Educate coaches and officials of the need for immediate CPR and AED Care. The longer the delay, the greater likelihood that death may occur. 5. Establish an emergency action plan at all athletic venues. Parents, coaches, and officials should be involved in these plans.
    [Show full text]
  • Recognition and Evaluation of Internal Injuries
    IDENTIFYING LIFE THREATENING INTERNAL INJURIES ON THE FIELD JARON SANTELLI, MD PRIMARY CARE SPORTS MEDICINE FELLOW EMERGENCY MEDICINE PHYSICIAN UNIVERSITY OF MARYLAND/MEDSTAR DISCLOSURES No financial disclosures GOALS: • Identifying tools at your disposal both on the field and in the training room • Discuss the primary and secondary survey • Identifying a handful of cardiac, pulmonary and gastrointestinal life threatening injuries • Identify possible life-saving interventions WHAT ARE THE BASIC ASSESSMENT TOOLS THAT YOU HAVE? OBJECTIVE INFORMATION • General Appearance • Vitals • Exam: Primary and Secondary Survey • Supplemental Tools VITALS • Heart Rate • Blood Pressure: BP cuff • Respiratory Rate • Oxygen Saturation • Temperature: Oral or Rectal EXAM A: Airway If they are talking to you this is intact B: Breathing Auscultation, watch for chest rise, equal bilateral C: Circulation Auscultate, assess pulses, especially at site of injury, bleeding D: Disability GCS, spine board, obvious trauma E: Environment PrimarySurvey Assess for safety, temperature EXAM HEENT: Oropharynx, bleeding, foreign body CV: Heart sounds quieter then normal? Fast or slow, regular or irregular, murmur? Are pulses equal left and right? PULM: Do you hear breath sounds bilaterally, are they equal? Labored, fast or slow, wheezing/crackles/rhonchi? GI/GU: External injuries or bruising? Tenderness/guarding/mass/rigidity? GU Inspection? SecondarySurvey* *Limited to scope of lecture SUPPLEMENTAL TOOLS • Blood Glucose • Urine: gross and dip stick • Basic Chemistry • Ultrasound
    [Show full text]
  • Traumatismes Thoraciques (Antoine MONSEL, Pitié-Salpêtrière)
    Traumatismes fermés du thorax Dr Antoine MONSEL Réanimation Chirurgicale Polyvalente (Pr Puybasset) Département d’Anesthésie-Réanimation (Pr Puybasset) DMU « DREAM » Hôpital Pitié-Salpêtrière Journée « traumatologie » 11 Avril 2019 prérequis Trauma thoracique Trauma fermé Trauma ouvert « blunt trauma » « penetrating trauma » • Lésions associés • E = ½ mV2 • balistique = fermé • polytraumatisme • Arme blanche → chirurgie +++ prérequis « Déchoc ou SSPI » prérequis « Déchoc ou SSPI » prérequis « Déchoc ou SSPI » prérequis « Déchoc ou SSPI » prérequis « Déchoc ou SSPI » prérequis « Déchoc ou SSPI » prérequis « Déchoc ou SSPI » prérequis « Déchoc ou SSPI » prérequis « Déchoc ou SSPI » prérequis prérequis Hiérarchisation lésionnelle Damage control ✓ HED ✓ Plaie de rate ✓ Bassin ✓ Rupture de l’isthme aortique ? ✓ Fracture ouverte déplacée du fémur prérequis The confluence of variables and a proposed mechanism necessary for commotio cordis to occur. Mark S. Link Circ Arrhythm Electrophysiol. 2012;5:425-432 Copyright © American Heart Association, Inc. All rights reserved. The confluence of variables and a proposed mechanism necessary for commotio cordis to occur. registre de Mineapolis 200 cas 25% de survie si une RCP est entreprise Mark S. Link Circ Arrhythm Electrophysiol. 2012;5:425-432 Copyright © American Heart Association, Inc. All rights reserved. The confluence of variables and a proposed mechanism necessary for commotio cordis to occur. registre de Mineapolis 200 cas 25% de survie si une RCP est entreprise Mark S. Link Circ Arrhythm Electrophysiol.
    [Show full text]
  • BLUNT Overview
    BLUNT Overview Chest trauma is a significant source of morbidity and mortality in the United States. This article focuses on chest trauma caused by blunt mechanisms. Penetrating thoracic injuries are addressed in Penetrating Chest Trauma. Blunt injury to the chest can affect any one or all components of the chest wall and thoracic cavity. These components include the bony skeleton (ribs, clavicles, scapulae, and sternum), the lungs and pleurae, the tracheobronchial tree, the esophagus, the heart, the great vessels of the chest, and the diaphragm. In the subsequent sections, each particular injury and injury pattern resulting from blunt mechanisms is discussed. The pathophysiology of these injuries is elucidated, and diagnostic and treatment measures are outlined. Morbidity and mortality Trauma is the leading cause of death, morbidity, hospitalization, and disability in Americans aged 1 year to the middle of the fifth decade of life. As such, it constitutes a major health care problem. According to the Centers for Disease Control and Prevention, 126,438 deaths occurred from unintentional injury in 2011.[1] Frequency Trauma is responsible for more than 100,000 deaths annually in the United States.[1] Estimates of thoracic trauma frequency indicate that injuries occur in 12 persons per 1 million population per day. Approximately 33% of these injuries necessitate hospital admission. Overall, blunt thoracic injuries are directly responsible for 20- 25% of all deaths, and chest trauma is a major contributor in another 50% of deaths. Etiology By far the most important cause of significant blunt chest trauma is motor vehicle accidents (MVAs). MVAs account for 70-80% of such injuries.
    [Show full text]
  • Coronary Thrombosis Without Dissection Following Blunt Trauma
    Hindawi Publishing Corporation Case Reports in Cardiology Volume 2016, Article ID 8671015, 4 pages http://dx.doi.org/10.1155/2016/8671015 Case Report Coronary Thrombosis without Dissection following Blunt Trauma Archana Sinha,1 Michael Sibel,2 Peter Thomas,3 Francis Burt,1 James Cipolla,3 Peter Puleo,1 and Keith Baker2 1 Division of Cardiovascular Disease, Saint Luke’s University Health Network, Bethlehem, PA 18015, USA 2Department of Emergency Medicine, Saint Luke’s University Health Network, Bethlehem, PA 18015, USA 3Department of Trauma Surgery, Saint Luke’s University Health Network, Bethlehem, PA 18015, USA Correspondence should be addressed to Archana Sinha; [email protected] Received 14 November 2015; Accepted 2 February 2016 Academic Editor: Manabu Shirotani Copyright © 2016 Archana Sinha et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Blunt trauma to the chest resulting in coronary thrombosis and ST elevation myocardial infarction (STEMI) is a rare but well- described occurrence in adults. Angiography in such cases has generally disclosed complete epicardial coronary occlusion with thrombus, indistinguishable from the findings commonly found in spontaneous plaque rupture due to atherosclerotic disease. In all previously reported cases in which coronary interrogation with intravascular ultrasound (IVUS) was performed in association with acute revascularization, coronary artery dissection was implicated as the etiology of coronary thrombosis. We present the first case report of blunt trauma-associated coronary thrombosis without underlying atherosclerosis or coronary dissection, as documented by IVUS imaging. 1.
    [Show full text]
  • Trauma Series: Chest Trauma By: Scott P. Whetsell MFRI Field Instructor
    Trauma Series: Chest Trauma by: Scott P. Whetsell MFRI Field Instructor Trauma Series: Chest Trauma LESSON PLAN TOPIC Chest Trauma TIME FRAME 3 hours LEVEL OF INSTRUCTION Cognitive (1.5 hours), Psychomotor (1.5 hours) LEARNING OBJECTIVES - Following the lecture, the student will have a greater understanding of the management of thoracic injuries in the trauma patient. - Following demonstration, the student will be able to assess, identify, and treat a variety of thoracic injuries. RESOURCES / PowerPoint Presentation MATERIALS NEEDED Trauma supplies for addressing thoracic injuries PRE-REQUISTIES None REFERENCES Brady Emergency Care, Thirteenth Edition Medscape MIEMSS National Institute of Health Trauma.org Wikipedia LESSON SUMMARY This lesson is designed to review thoracic injuries and treatment. ASSIGNMENTS None. LESSON OUTLINE INTRODUCTION a. Instructor Name b. We are going to discusschest trauma. MOTIVATOR Thoracic injuries pose a significant threat to survivability of our patients. Being able to identify, triage, and treat thoracic injuries can help decrease morbidity and mortality in these patients. STUDENT PERFORMANCE OBJECTIVES 1. Following the lecture, the student will have a greater understanding of the management of thoracic injuries in the trauma patient. 2. Following demonstration, the student will be able to assess, identify, and treat a variety of thoracic injuries. OVERVIEW In order to meet these objectives, we will: - discuss anatomy and physiology pertaining to the chest. - discuss assessment of the trauma patient. - discuss various thoracic injuries. - divide into groups of three to five members and practice the following practical skills: . Trauma Assessment (rapid and focused) Include both life threatening and non-life threatening injuries . Commotio cordis . Flail chest .
    [Show full text]