Abstract
The incidence of cardiac injury after blunt chest trauma is difficult to determine
and ranges from 8% to 76%. Moreover, the clinical presentation varies tremendously
without a real gold standard to exclude or document cardiac involvement. Electrocardiogram
as a single test is not sensitive or specific for diagnosing cardiac contusion. Furthermore,
creatine kinase MB is non-reliable in the setting of severe trauma involving the liver,
intestines or diaphragm. Although troponins T and I are highly specific for cardiac
injury, their sensitivity in the setting of trauma is poor. The echocardiogram is
very useful in the evaluation of trauma patients with suspected cardiac involvement.
However, poor windows in the setting of chest and lung injuries and in intubated patients
might be a major problem limiting the accuracy of transthoracic echocardiogram. On
the other hand, transesophageal echocardiogram seems to be more sensitive and specific
in trauma patients and should be the test of choice in patients with high clinical
suspicion for blunt cardiac trauma.
Keywords
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Article info
Publication history
Published online: August 03, 2007
Accepted:
October 2,
2006
Received in revised form:
May 16,
2006
Received:
July 1,
2005
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Confronting Blunt Cardiac TraumaJournal of Emergency MedicineVol. 47Issue 5
- PreviewI read with great interest the article by El-Chami et al. on blunt cardiac trauma (1). The authors explored the diagnosis and management of several forms of blunt cardiac trauma. Given the remarkable frequency of cardiac contusion in blunt chest trauma patients, especially those involved in motor vehicle accidents, I would like to comment on some of the issues raised in this well-written article.
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