4.4 CARDIAC CONTUSION

Question 1

Anatomy

Answer 1

The heart lies behind the sternum and left side of the rib cage

Question 2

Pathophysiology

Answer 2

(1) Blunt force trauma to the chest can cause myocardial contusion and
necrosis
(2) Myocardial tissues once contused begins to swell, causing pressure on
capillaries and decrease blood flow to injured myocardium which then
can lead to necrosis
(3) Commonly caused by high speed MVA, steering wheel in motor vehicle
accidents and other blunt force trauma.

Question 3

Symptoms/Physical Findings

Answer 3

(1) Commonly asymptomatic except for chest wall pain
(2) Severe anterior chest injury (broken ribs, chest wall contusion with
ecchymosis)
(3) Tachycardia disproportionate to the degree of trauma

Question 4

Differential Diagnosis

Answer 4

(1) Aortic dissection
(2) Esophageal rupture
(3) PTX
(4) Pericardial Tamponade
(5) AMI

Question 5

Labs/Studies/EKG

Answer 5

(1) EKG: sinus tachycardia is the most common finding. Look for possible
life threatening arrhythmias
(2) CXR: look for rib fractures, pulmonary contusion, broken collar bone

Question 6

Treatment

Answer 6

(1) ABC, IV, O2, Monitor
(2) Analgesics for pain control
(3) Monitor for 4-6 hours, if there is no hemodynamic instability apparent,
repeat EKG in 24 hours.
(4) Diagnose and treat any cardiac arrhythmias accordingly

Question 7

Initial Care

Answer 7

(1) Pain control with analgesics
(2) Monitor
(3) If suspect cardiac or pulmonary contusion then need to transfer to higher
level of care

Question 8

Complications

Answer 8

(1) AMI
(2) Cardiac Dysrhythmias
(3) Pericardial effusion
(4) Pericardial Tamponade
(5) Aortic dissection
(6) Pericarditis