7. "Surgery of the heart has probably
reached the limits set by nature to all
surgery: no new method and no
discovery can overcome the natural
difficulties that attend a wound of
the heart"
Paget, 1896
40. "Diagnosis is relatively simple: any trauma patient with
a likely mechanism who has chest wall pain and a
new arrhythmia or cardiac pump failure has a
cardiac contusion. Atrial or ventricular arrhythmias are
significant, but a ventricular one is significant because it
can degenerate into v-tach or worse.
Enzyme measurements do not indicate severity of
injury or outcome and should not be obtained.
Remember, true cardiac contusion is rare! If suspected,
telemetry is indicated, along with frequent vital signs.
Cardiac enzymes should not be ordered, and any indication
of cardiac problems (arrhythmia or failure) should be
reported and treated promptly."
http://regionstraumapro.com/tagged/cardiac-contusion
63. The liberal application of thoracotomy in the
resuscitation of blunt trauma cannot be
justified and should only be undertaken when
there are documented signs of life in the
emergency department or within five minutes
prior to arrival; prolonged (>5 mins) CPR
after blunt injury equates to fatality.
Emergency Thoracotomy – The Indications, Contraindications, and
Evidence. Morgan BS, Garner JP. JR Army Med Corps 155(2): 87-93
64. Cardiac Trauma Review
Maintain high suspicion
Blunt Cardiac Trauma
Penetrating Cardiac Trauma
When to perform ED Thoractomy
