Michael S. Blanc, FACC, FSCAI Medical Director Cardiac Trauma Basics Michael S. Blanc, FACC, FSCAI Medical Director Community Heart and Vascular Center San Angelo Community Medical Center San Angelo, TX

Chest Trauma Chest injuries result in a significant number of deaths each year The chest contains organs vital to life Damage to vital organs threatens life Most common consequence is hypoxia Injuries to the chest wall or internal organs can lead to ineffective ventilation and oxygenation. The EMT has to recognize the presence of chest injuries, quickly initiate the proper management, and facilitate expedient transport to the most appropriate hospital.

Chest Injuries Traumatic asphyxia Rapid ejection of blood and air out of chest Rapid compression of chest increases internal pressure dramatically Blood is immediately forced out of the chest and into the vessels in the neck, head, and face Traumatic asphyxia can be caused by the patient being crushed or pinned between two objects. The EMT should be prepared for the likely outcome of these types of injuries: most patients will die on scene.

Chest Injuries Cardiac contusion Can impair heart’s ability to pump Bleeding into heart tissue can cause heart to beat irregularly Irregular pulse should alert EMT to possibility of a cardiac contusion A massive cardiac contusion may decrease cardiac output and can result in hypotension. A large bruise forming on the anterior chest, along with chest pain and tenderness, may suggest a cardiac contusion.

Chest Injuries Cardiac contusion: Management High-flow oxygen Ventilation support as needed Support of circulation if appropriate Prompt transport Request ALS backup The patient suspected of having a cardiac contusion has suffered significant blunt trauma to the chest. Management priorities are similar to those of a patient with a pulmonary contusion. Care is primarily supportive.

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