Objectives

• Review the etiologies and consequences of cardiac and great vessel trauma.

• Discuss the clinical presentation of cardiac and great vessel trauma.

• Evaluate diagnostic strategies for cardiac and great vessel trauma.

• Be familiar with decision making and techniques of emergency thoracotomy, a potentially life-saving procedure.

• Identify hemorrhage control methods for cardiac and great vessel trauma that an emergency physician should be proficient with until a cardiovascular surgeon arrives.

• Discuss the definitive treatment of cardiac and great vessel trauma.

• Be familiar with the new applications of endovascular stenting techniques in aortic trauma.

SUMMARY

Blunt and penetrating cardiac and great vessel trauma are associated with potentially life-threatening injuries requiring a high index of suspicion. Cardiac tamponade is often associated with injury to the heart and may quickly lead to hemodynamic compromise, necessitating prompt diagnosis and intervention. The aorta and great vessels are most commonly injured in a blunt manner associated with multisystem trauma, often the result of rapid deceleration. The majority of patients succumb to this type of injury and do not survive to present at hospital. A high index of suspicion for cardiac and aortic injury should be present in any patient involved in trauma to the chest, and appropriate diagnostic measures should be taken once the patient is stabilized.

INTRODUCTION TO CARDIAC TRAUMA

The heart lies in the mediastinum between the two lungs and is enclosed within the pericardium.