RESUMO
Cardiac contusion following blunt chest trauma is not rare, and the works in the literature report incidence rates between 5 and 50%. Traffic accidents are the most frequent cause of cardiac contusion followed by violent fall impacts, aggressions and the practice of risky sports. The spectrum of post-traumatic cardiac lesions varies greatly, ranging from no symptoms to decrease in cardiac function. Cardiogenic shock is a rarely encountered manifestation of blunt cardiac contusion. We review our experience of cardiac contusion after blunt chest trauma, and we describe two very severe cases that manifested as cardiogenic shock. We emphasize an early diagnosis by continuous electrocardiographic monitoring, serial electrocardiograms, echocardiography, serum determination of biochemical cardiac markers, radionuclide imaging and coronary angiography. The treatment includes continuous monitoring of cardiac rhythm, use of inotropic drugs, insertion of a catheter in the pulmonary artery for continuous assessment of cardiac output and, in extreme cases, the insertion of a contrapulsation balloon to maintain haemodynamics until improvement of cardiac function.
Assuntos
Contusões/diagnóstico , Contusões/terapia , Tratamento de Emergência/métodos , Traumatismos Cardíacos/diagnóstico , Traumatismos Cardíacos/terapia , Acidentes por Quedas , Acidentes de Trabalho , Acidentes de Trânsito , Adulto , Traumatismos em Atletas/complicações , Débito Cardíaco , Cardiotônicos/uso terapêutico , Cateterismo de Swan-Ganz , Causalidade , Contusões/epidemiologia , Contusões/etiologia , Angiografia Coronária , Contrapulsação , Diagnóstico Precoce , Eletrocardiografia , Traumatismos Cardíacos/epidemiologia , Traumatismos Cardíacos/etiologia , Humanos , Incidência , Masculino , Monitorização Fisiológica/métodos , Choque Cardiogênico/etiologia , Traumatismos Torácicos/complicaçõesRESUMO
Gastric rupture following blunt abdominal trauma is rare, with a reported incidence of 0.02-1.7%. Road traffic accidents remain the most frequent cause. The factors most often implicated in the genesis of this entity are: a history of a recent meal, trauma to the left side of the body and an inappropriate use of seat belts. Splenic injury is generally the most common associated injury. The high morbidity and mortality are directly related to the number of associated injuries, delays in diagnosis and the development of intraabdominal sepsis. We performed a retrospective study of 1300 patients with blunt trauma to the abdomen from 1973 to 2001. Seven patients sustained a gastric rupture (five men and two women). The following associated characteristics were analysed: mechanism of injury, clinical presentation, possible associated injuries and postoperative complications, diagnosis methods and surgical treatment. We found an incidence of gastric rupture of 0.5%. We emphasise an early diagnosis and aggressive surgical treatment as a key to decreasing the mortality and morbidity from this injury. However, in our series, the morbidity is mainly from associated injuries.
