Cardiac tamponade. Aortic Dissection. Blunt cardiac injury.

Cardiac Tamponade

* Blood fills pericardial sac* Increasing pressure on myocardium -> Decreased preload* Decreased preload -> Hypotension -> Death* Clinical exam shows Beck’s Triad* Hypotension* Muffled heart sounds* Jugular venous distension (JVD)* Diagnosed during FAST exam (subxiphoid view)* Treat with pericardiocentesis* Bedside thoracotomy if patient loses pulse

Aortic Dissection/Rupture/Tear

* Common with rapid deceleration injuries* Most commonly occurs at ligamentum arteriosum* Small ligament that attaches arch of aorta to pulmonary artery* Remnant of the ductus arteriosus* Obtain CTA of the chest if…* Widened mediastinum on chest x-ray* Unequal pulses* Concerning mechanism of injury* Requires emergent repair

Blunt Cardiac Injury

* Contusion to the myocardium can cause arrhythmia/death* Place patient on cardiac monitor* Consider EKG/troponin* Commotio Cordis* Blunt impact to chest resulting in ventricular fibrillation

Additional Reading

* Blunt Cardiac Injury (American Association for the Surgery of Trauma)* FAST Exam (SAEM)