AMC Trauma Practice Management Guideline: Blunt Cardiac Injury Created: 4/2108 Revised: 1/2019 AMC Trauma Practice Management Guideline: Blunt Cardiac Injury PURPOSE: Outline an evidence based, protocoled approach to diagnosis and management of blunt cardiac injury (BCI) PROBLEM: Blunt cardiac injury can be difficult to diagnose. It is hard to distinguish cardiovascular collapse from other causes of hypotension in the severally injured trauma patient. There is also no specific injury (i.e.. sternal fracture) associated with a higher risk of BCI. Therefore, anyone with severe blunt trauma to the chest should be considered for screening for BCI to determine disposition status and need for further monitoring Recommendations: Level 1: An admission EKG should be obtained on all patients suspected of having a BCI Level 2: A. Any new abnormality (arrhythmia, ST changes, ischemia, heart block) on EKG should prompt continuous ECG monitoring. For those with preexisting EKG abnormalities, a comparison should be done with previous EKGs to determine need for monitoring. B. In patients with a normal EKG and normal troponin I level, BCI is ruled out. No further monitoring or imaging is indicated. C. Only patients with hemodynamic instability or a persistent new arrhythmia should have an echocardiogram performed. D. The presence of a sternal fracture alone does not predict the presence of BCI and does not require further monitoring or work-up in patients with a normal EKG and troponin I level. E. CPK and isoenzyme analysis should not be performed Level 3: A. Elderly patients with known cardiac disease, unstable patients, and those with abnormal EKG findings can safely undergo surgery with appropriate intraoperative monitoring B. Troponin I should be measured routinely for patients with suspected BCI; If elevated, the patient should be admitted to a monitored setting and the troponin I should be serially measured. Implementation: A. Anyone with severe blunt trauma to the chest should be considered for screening of BCI. B. Those suspected have having BCI should have an EKG and a troponin level drawn. If both are normal, no telemetry monitoring or echocardiogram is warranted C. Any abnormality on EKG or troponin level should prompt monitoring on telemetry and repeat troponin levels D. An echocardiogram is only warranted in hemodynamically unstable patients or in work-up for another underlying issue (syncope, MI, etc.). REFERENCES Screening for Blunt Cardiac Injury: East Clinical Guidelines. J Trauma. 73(5):S301-S306, November 2012 Created: 4/2108 Revised: 1/2019 .