- Chest Traumatic Injury
- High speed injury (e.g. MVA)
- Sternal Fracture
- Bent stearing wheel in a Motor Vehicle Accident
- Hypotension
- Anterior chest wall injury
-
Sternal Fracture signs
- Sternal tenderness
- Sternal deformity
- Serial Troponin levels
- Standard Troponin at 4-6 hours or High Sensitivity Troponin at 3 hours after injury
- Telemetry monitoring
-
Electrocardiogram (EKG) - obtain serial EKGs
- See EKG monitoring in Trauma
- Changes occur typically in first 8-24 hours of injury and typically resolve spontaneously
- Premature Ventricular Contractions (PVC)
- Unexplained Sinus Tachycardia
- Atrial Fibrillation (most common Arrhythmia)
- Right Bundle Branch Block
- ST Segment changes
- Myocardial Infarction may occur in blunt cardiac Trauma
- Advanced hemodynamic monitoring (if central access)
- Central Venous Pressure increased
-
FAST Exam
- Pericardial Effusion may be present
-
Echocardiogram
- Wall motion abnormality
- Right Ventricle is most commonly injured chamber in Sternal Fracture
- Evaluate for valvular injury
- Normal Troponin, EKG, hemodynamic and cardiac monitoring without significant other Chest Injury
- Unlikely to have significant cardiac injury
- May be discharged home after 6 hour observation
- Abnormal Troponin, EKG hemodynamic or cardiac monitoring (esp. in displaced Sternal Fracture, other Chest Trauma)
- Complete full evaluation with Echocardiogram, telemetry, trauma Consultation
- See Blunt Chest Trauma
- See associated conditions below
- Rib Fracture
- See Blunt Chest Trauma
- Heart Injury
- Valve Rupture
- Coronary Artery Dissection
- Cardiac Chamber Rupture
- Cardiac Tamponade
- Commotio Cordis
- Other Chest Injury
- ABC Management
- Manage Hypoxia, Hypotension and identified complications
- Indications for observation (24-48 hour)
- See Evaluation above
- Complications (see below) are most likely to present in the first 24-48 hours
- Cardiogenic failure
- Arrhythmia (including lethal, ventricular Arrhythmia)
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21
- (2012) ATLS, ACOS, p. 105
- Killu and Sarani (2016) FCCS, p. 160-1