Blunt chest trauma: a challenge to accident and emergency nurses.

The incidence of myocardial contusion as a result of blunt chest trauma remains difficult to assess. As such the potentially lethal consequences are often difficult to mitigate against. The true incidence of myocardial contusion is not known and various authors have ascribed percentages in the very broad range of 8-71% of those having suffered blunt chest trauma. The extremely wide variation in presenting signs and symptoms further complicates the clinical picture creating a complicated and complex challenge for the assessing team. In the absence of clear guidelines to date a number of potential options are discussed exploring their efficacy and appropriateness in the management of those patients suffering from blunt chest trauma.

Cardiac contusion: two case vignettes.

When patients with blunt chest trauma and suspected cardiac contusion are brought to the emergency department, focus on detecting subtle signs of myocardial dysfunction. Obtain the important first EKG, monitor for arrhythmia development, and assess for signs of failure of the right side of the heart.

Clinical manifestations of blunt cardiac injury: a challenge to the critical care practitioner.

Life-threatening cardiac emergencies following blunt chest trauma demand accurate assessments and rapid interventions to prevent unnecessary complications and death. Critical care practitioners must recognize the subtle clues that indicate cardiac trauma and the decompensation that occurs if the injuries are not recognized early. Blunt cardiac trauma can manifest as myocardial concussion with an associated low mortality or as cardiac rupture with an excessive mortality. Traditional diagnostic laboratory studies such as cardiac enzymes have proven ineffective in the trauma patient population. Therefore, the role of the critical care practitioner is centered on assessing patients for the clinical manifestations of decreased myocardial performance, particularly those patients with limited cardiac reserve.

Cardiac contusion in a 2 1/2-year-old child.

This case was unique in that we were seeing signs and symptoms of a cardiac contusion 11 hours after injury, when cellular edema was causing lethal bradyarrhythmias and hypotension. Keeping the possibility of a cardiac contusion in mind when caring for pediatric patients with trauma and including a 12-lead EKG more routinely for pediatric patients with chest trauma would increase identification of potential problems as early as possible. Although cardiac contusion is not common in children, it must not be overlooked.

Myocardial contusion. Using the index of suspicion for assessing blunt chest trauma.

The body of literature devoted to the diagnosis and treatment of the patient with myocardial contusion (MC) frequently references the "index of suspicion" to qualify those patients at risk for cardiac embarrassment. Absent from this literature, however, is discussion of the importance of diligent nursing assessment and monitoring of these patients. This article shows the relevance of the index of suspicion to the nursing assessment of patients suspected of myocardial injury from blunt chest trauma.

Cardiovascular trauma.

Cardiac trauma affects people of all ages from all walks of life. The exact incidence of cardiac trauma is unknown because many individuals die before ever reaching a medical facility for treatment. Reduction in the time from cardiac injury to definitive treatment with continued improvement in rapid emergency transport systems will result in a lower mortality rate. The challenge for nursing is to reduce mortality of victims of cardiac trauma further with prompt nursing diagnosis and effective nursing interventions.

Chest injuries in the trauma patient.

The primary survey of a trauma victim always begins with the ABCs used in resuscitation. Chest trauma compromises the normal physiology of respiration and circulation. Although some chest injuries are overt, some are not. The mechanism of injury is important for increasing the degree of suspicion used to identify covert injuries. The most lethal injuries include tension pneumothorax, sucking chest wound, massive hemothorax, flail chest, and cardiac tamponade. Cardiac and aortic ruptures often cause death before the victim enters the health care system. Potentially lethal injuries include myocardial and pulmonary contusion, tracheobronchial disruption, and esophageal disruption. Trauma victims present with many combinations of chest injuries. The care of these patients is very complex. Nursing diagnoses guide the care of chest trauma patients and can include impaired gas exchange, alteration in cardiac output, and altered breathing pattern. The goal of treatment is to restore and maintain stable hemodynamics with adequate respirations and circulation allowing definitive treatment for a positive patient outcome.

Nursing assessment of blunt cardiac trauma.

Cardiac injuries due to blunt trauma are common and contribute to the overall mortality of the trauma victim. Such injuries may be difficult to detect, and the clinician must maintain a high degree of suspicion for their presence. Clinical findings are nonspecific, but the nurse should focus on assessing the adequacy of cardiac output and tissue perfusion. Initial management of the patient with blunt cardiac trauma is the same as for any trauma patient: stabilization of airway, breathing, and circulation. Intravascular volume replacement is an important aspect of the resuscitation. Injuries such as aortic transection or ventricular rupture lead to exsanguination and the need for rapid infusion of large volumes of blood. On the other hand, cardiac function may be severely depressed with myocardial contusion and septal or valvular rupture; volume replacement must proceed cautiously.