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