Cardiac Contusion

 

 

Considerations

 

  • Trauma patient & need for ATLS approach, other occult injuries

  • Potential emergency with arrhythmias, cardiogenic shock 

 

 

Complications

 

  • Early: arrhythmias, myocardial rupture, valvular damage, thrombosis 

  • Late: ventricular aneurysm, dilated cardiomyopathy, pericarditis, ventricular arrhythmias 

 

 

Conflicts

 

  • Hemodynamic instability vs. rapid sequence intubation in trauma setting

  • Hemodynamic instability vs. operative management of other significant injuries

 

 

Optimization/Goals

 

  • Determine extent of myocardial injury (troponin, ECG, echo)

  • Admit to ICU for monitoring

  • Use invasive monitoring as appropriate

  • Manage cardiogenic shock: invasive monitoring, fluid resuscitation, inotropes/pressors, intra-aortic balloon pump