Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

A1-G Surg Note Trauma > Blunt Cardiac Injury > Flashcards

Blunt Cardiac Injury Flashcards

1
Q

What condition is often suspected in patients with blunt thoracic injury and sternal fracture?

A

Myocardial contusion

Elevated cardiac enzymes/Abnormal ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

In what types of injuries should blunt cardiac injury (BCI) be considered?

A

High-speed impacts to the thorax
motor-vehicle collisions
bicycle or motorcycle crashes
falls greater than 10 feet
blast injuries, assaults
crush injuries to the chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What mechanisms can cause blunt cardiac injury (BCI)?

A

Direct precordial impact
compression or crush between the sternum and spine
deceleration/torsion force causing a cardiac tear at a fixed point (e.g., between the right atrium and vena cava).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How can an abrupt compression of the abdomen lead to blunt cardiac injury (BCI)?

A

causing a significant and sudden rise in venous pressure transmitted to the right heart, potentially resulting in cardiac rupture.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What combination of tests can rule out significant blunt cardiac injury (BCI)?

A

normal ECG and troponin I level on admission and 8 hours later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is significant blunt cardiac injury (BCI) defined?

A

presence of cardiogenic shock
arrhythmias requiring treatment
posttraumatic structural deficits.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does the initial chest radiograph help rule out in diagnosing blunt cardiac injury (BCI)?

A

Tension pneumothorax and/or hemothorax as sources of blood loss and hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How can spinal cord injury be ruled out as a cause of hypotension before intubation?

A

By confirming movement of the lower extremities and checking for rectal tone during the physical examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does the FAST examination aid in diagnosing blunt cardiac injury (BCI)?

A

-determine cardiac activity in patients without vital signs
-identifies fluid in the pericardial sac in patients with vital signs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What imaging is recommended for patients with abnormal ECGs on admission

A

A transthoracic echocardiogram (TTE) or transesophageal echocardiogram (TEE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What characterizes Grade 1 blunt cardiac injury (BCI)?

A

ECG abnormalities
nonspecific ST or T-wave changes
premature atrial or ventricular contractions
or persistent sinus tachycardia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What characterizes Grade 2 blunt cardiac injury (BCI)

A

Heart block or ischemic changes without cardiac failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What characterizes Grade 3 blunt cardiac injury (BCI)?

A

Sustained arrhythmias
septal rupture
valvular incompetence
papillary muscle dysfunction
distal coronary artery occlusion without heart failure
or blunt pericardial laceration without cardiac herniation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What characterizes Grade 4 blunt cardiac injury (BCI)?

A

Septal rupture
pulmonary or tricuspid incontinence
papillary muscle dysfunction
distal coronary artery occlusion with cardiac failure, rupture of the atria or right ventricle
or aortic/mitral valvular incompetence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What characterizes Grade 5 blunt cardiac injury (BCI)?

A

Proximal coronary artery occlusion
left ventricular perforation
or rupture of more than one chamber.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How should patients with Grade 1 blunt cardiac injury (BCI) be managed?

A

observed with continued monitoring until the ECG abnormalities have corrected
Within 24 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How should patients with Grade 2 blunt cardiac injury (BCI) be managed?

A

monitored until ischemic changes resolve and the ECG returns to normal.
serial assessment of troponin levels
Within 48 hours Resolve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How should patients with Grade 3 blunt cardiac injury (BCI) and ventricular arrhythmias be managed?

A

monitored closely for progression to cardiac failure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What should be checked in Grade 3 BCI patients with pericardial fluid?

A

evidence of pericardial tamponade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What types of injuries are associated with Grade 4 blunt cardiac injury (BCI)?

A

Septal rupture, valvular incompetence, or chamber rupture of the right ventricle, either atrium, or the right atrial appendage

21
Q

How are Grade 4 BCI patients with valvular incompetence or papillary muscle dysfunction diagnosed?

A

reduced ejection fraction or dyskinesis, which can be identified on imaging

22
Q

What evidence might Grade 4 BCI patients with distal coronary artery occlusion exhibit?

A

Signs of cardiac ischemia and inotropic compromise

23
Q

Do Grade 4 BCI patients always require operative intervention?

A

No, they usually do not require surgery unless there is a chamber rupture.

24
Q

How should pericardial tamponade be detected and confirmed?

A

Detected by initial FAST examination and confirmed by CT scan

25
Q

What is the definitive care for pericardial tamponade in this context?

A

Transthoracic pericardiocentesis followed by a prompt left anterior thoracotomy

26
Q

What caused the engorged purple liver in this patient with pericardial tamponade?

A

Impaired hepatic venous return due to the tamponade.

27
Q

Which heart chambers are most commonly ruptured in BCI?

A

The right atrium or ventricle (65%), followed by the left ventricle

28
Q

What is commotio cordis?

A

Sudden death from cardiac arrest without any anatomic structural damage to the heart, typically after a blunt blow to the chest
In young people during competitive sporting
blunt impact induces ventricular fibrillation during a vulnerable phase of ventricular excitability, such as cardiac repolarization.
often refractory to CPR and defibrillation

29
Q

What is the next step if a patient with blunt thoracic trauma presents without vital signs?

A

A FAST examination should be done to determine if there is cardiac activity. If absent, no further action is taken

30
Q

What should be done for a normotensive patient after blunt thoracic trauma?

A

A FAST examination should be performed as part of the secondary survey
followed by ECG and troponin measurements if no pericardial fluid is detected

31
Q

What is the next step if the ECG and troponin are normal in a patient after blunt thoracic trauma

A

No further tests or monitoring for BCI is indicated

32
Q

What should be done if the ECG and/or troponin are abnormal with findings such as tachycardia, arrhythmia, or ST elevation?

A

The patient should be admitted to the ICU, and the ECG and troponin levels should be repeated in 6 hours. An echocardiogram should be done within the first 24 hours

33
Q

How are patients with BCI typically managed if their echocardiogram is abnormal?

A

The echocardiogram should be repeated in 48 to 72 hours, and treatment is supportive, including β-blockers for tachycardia and ventilatory support for pulmonary injury.

34
Q

What should be excluded first when a patient with blunt thoracic trauma presents with hypotension?

A

Spinal cord injury
tension pneumothorax
or other sites of hemorrhage, including the chest or fractures.

35
Q

How does a FAST examination help in hypotensive patients with blunt thoracic trauma

A

determine if there is fluid in the pericardial sac.

36
Q

What should be done if pericardial fluid is present and the patient is stable?

A

A CT of the chest is recommended to distinguish between serous fluid (e.g., from renal failure) and blood.

37
Q

What is the recommended action if pericardial fluid appears to be blood and the patient is stable?

A

Immediate surgery is indicated.

38
Q

What is the next step if a hypotensive patient with pericardial fluid is unstable?

A

Pericardiocentesis should be performed on the way to the operating room

39
Q

What is the recommended surgical approach for blunt cardiac injury (BCI) requiring repair?

A

left anterolateral thoracotomy for rapid access and pericardiotomy.

40
Q

What is the recommended surgical repair for atrial or atrial appendage injuries in BCI?

A

A simple primary repair using 2-0 silk sutures on a noncutting needle, with digital pressure to control bleeding.

41
Q

What surgical option is available if a left thoracotomy limits access to the heart?

A

The incision can be extended across the sternum into the right chest, creating a clamshell thoracotomy.

42
Q

What might cause blood in the pericardial sac without heart rupture in blunt cardiac injury (BCI)?

A

Bleeding from the pericardial sac itself.

43
Q

How should the pericardium be managed postoperatively if there is bleeding from the pericardial sac?

A

The pericardium should be approximated, leaving a 3-4 cm opening in the nonapical part to allow egress of postoperative pericardial blood.

44
Q

What other injuries often accompany BCI and require definitive management?

A

Severe pulmonary injuries.

45
Q

What type of injuries may require cardiopulmonary bypass for repair in BCI?

A

Rupture of a heart valve or papillary muscle, which may be detected on echocardiogram

cardiopulmonary bypass > repair of any chamber rupture

46
Q

What surgical approaches are recommended for blunt cardiac injury (BCI) that requires repair?

A

definitive median sternotomy or a left thoracotomy.

47
Q

How is the pericardium opened during surgery for BCI?

A

opened parallel to the phrenic nerve.

48
Q

What is the next step after opening the pericardium in BCI surgery?

A

blood is evacuated, and the heart is examined for injury

49
Q
A

A1-G Surg Note Trauma (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions