CARDIAC INJURY -
Biljana Radisavljević, Dušan Gostović, Snežana Mitrović, Radica Krstić
Emergency Medical Service Niš, Serbia
Introduction. Chest injuries are of particular significance for their potential to compromise respiratory and/or circulatory function. Thoracic trauma can result from blunt and penetrating mechanisms. Rescuers in the field usually pay attention to the traumas of the chest wall and the lung tissue, and rarely think about cardiac injury.
Aim. To point out to the importance of cardiac injury in chest trauma.
Data sources and data extraction. A retrospective analysis of the literature with keywords: trauma, chest, and cardiac injury. The search is performed through: PubMed, Medline and electronic journals available through KoBSON as well as publications available in the Faculty of Medicine in Nis Library. (PHTLSChapter 11Thoracic trauma).
Results of data synthesis. Blunt cardiac injury often results from cardiac compression due to application of force to the anterior chest causing the following entities:
• Cardiac contusion. Often causes abnormal heart rhythms e.g. sinus tachycardia, premature ventricular contractions, ventricular tachycardia, ventricular fibrillation and intraventricular conduction abnormalities. The contractility of the heart may be impaired, and cardiac output falls, resulting in cardiogenic shock.
• Valvular rupture. Rupture of the supporting structures of the heart valves or the valves themselves causes a reduction in their functions with symptoms and signs of congestive heart failure.
• Blunt cardiac rupture. Occurs in less than 1% of patients with blunt chest trauma. Most of these patients will die at the scene from exsanguination or fatal cardiac tamponade. The surviving patients will present with cardiac tamponade. The increase of pressure in the pericardium prevents the return of venous blood to the heart and leads to a reduction in cardiac output. With each cardiac contraction this condition deepens and leads to the heart's electrical activity without a pulse. Most frequently, cardiac tamponade occurs due to stab wounds to the heart penetrating to the cardiac chambers or myocardial laceration. Rupture of the chamber due to blunt chest injuries frequently causes massive bleeding. The level of suspicion of cardiac tamponade should be raised to "present until proven otherwise" when the injury occurs is within a rectangle (the cardiac box) formed by drawing a horizontal line along the clavicles, vertical lines from the nipples to the costal margins, and a second horizontal line connecting the points of intersection between the vertical lines and the costal margin.
Physical signs of threatening cardiac tamponade (Beck's triad) are: remote, dull, muffled heart sounds, jugular venous distension, low blood pressure.
Assessment. Assessment of the patient with the potential for blunt cardiac injury reveals a mechanism of injury and physical signs.
Management. The key management strategy is correct assessment that cardiac injury may have occurred and transmission of those data to the receiving facillity. A high concentration of oxygen is to be administered, and IV access established along with fluid replacement. The patient should be connected to the ECG monitor. If arrhythmia is present, standard antiarrhythmic therapy should be administered. In pericardial tamponade, removal of smaller amounts of fluid from the pericardium by pericardiocentesis is an effective temporary measure.
Conclusion. Cardiac injuries may cause serious complications with fatal outcome, requires correct assessment of the mechanism of injury, urgent treatment and rapid, monitored transport to a facility that can perform immediate surgical repair as soon as it is recognized. After a primary survey, the patient should be managed on the way to hospital. Even when there are no outer signs of chest trauma, special care should be taken in the area of the cardiac box because these injuries may cause fatal complications and lethal outcome.
Keywords: trauma, chest, cardiac injury
Biljana RADISAVLJEVIĆ, MD
Emergency Medical Service Nis, Serbia
E mail: firstname.lastname@example.org
Rad primljen: 12.12.2015
Rad prihvaćen: 26.12.2015.
Elektronska verzija objavljena: 01.02.2016.
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