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Cardiac Trauma Lecture
This document provides an overview of cardiac trauma, including both blunt and penetrating trauma. It discusses the history of cardiac surgery and treatments. For blunt cardiac trauma, it covers injury patterns, roles of ECG, cardiac enzymes, radiology, and clinical management. Penetrating cardiac trauma has higher mortality than blunt trauma. Prehospital considerations are to scoop and run the patient. The document advises when emergency department thoracotomy may be indicated for resuscitation of penetrating trauma. It concludes with reminding readers to maintain a high suspicion for cardiac trauma.
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Cardiac Trauma Lecture
- 1. CARDIAC TRAUMA A primeron blunt and penetrating heart trauma and pearls for emergency care
- 2. Jeremy Webb, M.D. PGY-3,Emergency Medicine Wake Forest Baptist Health
- 3. Topics Covered History: A Paradigm Shift Blunt Cardiac Trauma Penetrating Cardiac Trauma Role of Emergency Department Thoracotomy
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- 7. "Surgery of theheart has probably reached the limits set by nature to all surgery: no new method and no discovery can overcome the natural difficulties that attend a wound of the heart" Paget, 1896
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- 13. “the road tothe heart is only 2 or 3 cm, in a direct line, but it has taken surgery nearly 2400 years to travel it." - Harry Sherman, 1902
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- 15. What are themechanisms of injury?
- 19. What injury patternscan be seen?
- 21. Location Pearls Right heart > Left heart Left heart valves > Right heart valves Rupture: Atria > Ventricles
- 22. History and Physical Pulse?, Pain, Palpitations Extremis? Tamponade? Heart Failure? Associated injuries?
- 24. Pulsus Paradoxus Pulse?, Pain,Palpitations Extremis? Tamponade? Heart Failure?
- 26. Blunt Cardiac Injury Myocardial Contusion
- 27. Role of ECG Mandated if BCI suspected Sensitivity? Specificity? Common abnormalities in BCI
- 30. Dr. Steven W.Smith, Hennepin County Medical Center http: //hqmeded-ecg.blogspot.com/search/label/myocardial% 20contusion
- 31. The Role ofCardiac Enzymes Controversial Sensitivity? Specificity? When to test?
- 33. Enzymes Made Simple "Intermediate Risk" of BCI ECG Changes Hemodynamically Unstable Medical work-up (syncope, ischemia)
- 34. Role of Radiology Studyof Choice: Echocardiography Angiography as adjunct Indications?
- 36. Radiography Made Simple Hemodynamically Unstable: FAST ECG or Enzyme Abnormalities High Clinical Suspicion: Mechanism or associated injuries
- 37. BCI: Putting itAll Together
- 39. Words from aTrauma Surgeon...
- 40. "Diagnosis is relativelysimple: any trauma patient with a likely mechanism who has chest wall pain and a new arrhythmia or cardiac pump failure has a cardiac contusion. Atrial or ventricular arrhythmias are significant, but a ventricular one is significant because it can degenerate into v-tach or worse. Enzyme measurements do not indicate severity of injury or outcome and should not be obtained. Remember, true cardiac contusion is rare! If suspected, telemetry is indicated, along with frequent vital signs. Cardiac enzymes should not be ordered, and any indication of cardiac problems (arrhythmia or failure) should be reported and treated promptly." http://regionstraumapro.com/tagged/cardiac-contusion
- 45. Blunt Cardiac Injury Commotio Cordis
- 47. Blunt Cardiac Injury Myocardial Rupture
- 48. Blunt Cardiac Injury Cardiac Luxation
- 50. Penetrating Cardiac Trauma
- 51. Mortality by Mechanism GunshotWounds > Stab Wounds Exsanguination, Tamponade
- 53. Prehospital Considerations SCOOP ANDRUN SAVES LIVES!
- 54. Airway Considerations The laryngoscopeas a murder weapon...
- 56. Airway Considerations Sympathetic Crash Cause Tamponade Air Embolism
- 57. Diagnosis and Treatment Pericardiocentesis NOPE Subxiphoid Window FAST Pre-Operative Resus LIMITED !!! GET THEM TO AN OR QUICKLY !!!
- 58. Emergency Department Thoracotomy When to make a stab wound of your own...
- 63. The liberal applicationof thoracotomy in the resuscitation of blunt trauma cannot be justified and should only be undertaken when there are documented signs of life in the emergency department or within five minutes prior to arrival; prolonged (>5 mins) CPR after blunt injury equates to fatality. Emergency Thoracotomy – The Indications, Contraindications, and Evidence. Morgan BS, Garner JP. JR Army Med Corps 155(2): 87-93
- 64. Cardiac Trauma Review Maintain high suspicion Blunt Cardiac Trauma Penetrating Cardiac Trauma When to perform ED Thoractomy
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