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Doornkamp RN, van Winden DF, Buiten MS, Josephus Jitta D. Karate kick-induced myocardial contusion. BMJ Case Rep 2024; 17:e257082. [PMID: 38272515 PMCID: PMC10826487 DOI: 10.1136/bcr-2023-257082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2023] [Indexed: 01/27/2024] Open
Abstract
Myocardial contusion should be suspected in a selected patient group with blunt thoracic trauma, who have elevated troponin, ECG changes and/or haemodynamical instability. Echocardiography is useful for direct visualisation of possible complications. In stable conditions, MRI allows for good visualisation of the heart and can confirm a suspected myocardial contusion as well as demonstrate the extent of myocardial damage. Based on the present literature, the authors developed a diagram for the diagnostic approach of a patient with suspected myocardial contusion.
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Affiliation(s)
- Ruben N Doornkamp
- Department of Emergency Medicine, Medisch Centrum Haaglanden Westeinde, Den Haag, Zuid-Holland, The Netherlands
| | - Daniëlle Fm van Winden
- Department of Emergency Medicine, Medisch Centrum Haaglanden Westeinde, Den Haag, Zuid-Holland, The Netherlands
| | - Maurits S Buiten
- Department of Cardiology, Medisch Centrum Haaglanden Westeinde, Den Haag, Zuid-Holland, The Netherlands
| | - Djike Josephus Jitta
- Department of Cardiology, Medisch Centrum Haaglanden Westeinde, Den Haag, Zuid-Holland, The Netherlands
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2
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Zinoune L, Darar C, Aichouni N, Nasri S, Skiker I, El Ouafi N, Bazid Z. Early bilateral pulmonary embolism following a moderate blunt chest trauma: A case report. Radiol Case Rep 2022; 17:759-762. [PMID: 35003476 PMCID: PMC8718493 DOI: 10.1016/j.radcr.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 11/27/2022] Open
Abstract
Post-traumatic pulmonary embolism (PE) remains a major problem in cardio-pulmonary diseases and represent the third most common cause of death in trauma patients. Traditional PE occur most commonly between the fifth and the seventh day after a major trauma and are rare before the fourth day. Here, we report a case of acute pulmonary embolism developing 1 day after a moderate thoracic injury in a previously well young man. The diagnosis was made by non-invasive methods and the patient was given anticoagulation therapy with good outcome. The circumstances and the early occurrence of PE in this case is at odds with what is generally reported after trauma.
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Affiliation(s)
- Lamyae Zinoune
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Cardiology, Mohammed VI University Hospital/Mohammed I University, Oujda, Morocco
| | - Charmake Darar
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Cardiology, Mohammed VI University Hospital/Mohammed I University, Oujda, Morocco
| | - Narjisse Aichouni
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Radiology, Mohammed VI University Hospital/Mohammed I University, Oujda, Morocco
| | - Siham Nasri
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Radiology, Mohammed VI University Hospital/Mohammed I University, Oujda, Morocco
| | - Imane Skiker
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Radiology, Mohammed VI University Hospital/Mohammed I University, Oujda, Morocco
| | - Noha El Ouafi
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Cardiology, Mohammed VI University Hospital/Mohammed I University, Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Zakaria Bazid
- Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.,Department of Cardiology, Mohammed VI University Hospital/Mohammed I University, Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Oujda, Morocco
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3
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Mansour J, Raptis DA, Bhalla S. Multimodality Imaging of Cardiac Trauma. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00907-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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4
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Forteleoni A, Montereggi F, Sanna GD, Portoghese M, Parodi G. Traumatic mitral valve regurgitation. J Cardiovasc Med (Hagerstown) 2019; 20:709-717. [DOI: 10.2459/jcm.0000000000000809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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5
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Siado SA, Martínez-Montalvo CM, Osorio M, Gómez A, Jiménez HC. Utilidad de las pruebas diagnósticas en el trauma cardiaco cerrado. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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6
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Effect of nitric oxide synthase inhibitors in acute lung injury due to blunt lung trauma in rats. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 27:63-72. [PMID: 32082829 DOI: 10.5606/tgkdc.dergisi.2019.15936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/01/2018] [Indexed: 01/10/2023]
Abstract
Background This study aims to investigate the effects of blunt lung trauma performed in experimental rat model on lung tissue and blood as well as proinflammatory cytokines, oxidant-antioxidant enzymes and histopathological parameters after Ngamma-nitro-L-arginine methyl ester and N-iminoethyl-L-ornithine administration. Methods The study included 50 adult male Wistar albino rats (weighing 350 to 400 g). Rats were randomly allocated into four groups. Except in the control, moderate-level pulmonary contusion was created in all other groups. Intraperitoneal saline solution was performed in groups 1 and 2, 25 mg.kg-1 Ngamma-nitro-L-arginine methyl ester in group 3, and 20 mg.kg-1 N-iminoethyl-L-ornithine in group 4. Blood and lung tissues were studied biochemically and histopathologically. Results Best outcomes were recorded statistically significantly in groups with administration of Ngamma-nitro-L-arginine methyl ester and N-iminoethyl-L-ornithine when malondialdehyde response, mucous and histopathological values were examined. Significant improvement was detected in superoxide dismutase values in the group with administration of competitive nitric oxide synthase inhibitor Ngamma-nitro-L-arginine methyl ester. Nitric oxide values were substantially decreased in N-iminoethyl-L-ornithine group, while no significance was detected. Conclusion Free oxygen radicals and lipid peroxidation played a role in pulmonary contusion after blunt lung trauma. According to biochemical and histopathological outcomes, effects of inflammation were decreased and protective effects were formed with administration of both Ngammanitro- L-arginine methyl ester and N-iminoethyl-L-ornithine.
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Ruby RE, Wong DM, Ware WA, Ackermann MR. Myocardial Fibrosis and Ventricular Tachyarrhythmia in a Thoroughbred Filly. J Equine Vet Sci 2018. [DOI: 10.1016/j.jevs.2018.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Decavèle M, Gault N, Gauss T, Pease S, Moyer J, Paugam-Burtz C, Foucrier A. Cardiac troponin I as an early prognosis biomarker after trauma: a retrospective cohort study. Br J Anaesth 2018; 120:1158-1164. [DOI: 10.1016/j.bja.2018.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 02/23/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022] Open
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Abstract
Myocardial contusion can be a difficult diagnosis to make. There is currently no gold standard of investigation that allows its accurate diagnosis in the clinical setting. Trauma surgeons need to have a high degree of clinical suspicion when dealing with patients who have received blunt thoracic injuries in order that the diagnosis of myocardial contusion may be made. In this article we discuss the diagnosis, potential complications and investigation of patients with suspected myocardial contusion and also present a fl ow diagram for the possible management of patients with trauma who may have suspected myocardial contusion.
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Affiliation(s)
- AM Ranasinghe
- Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Trust, Birmingham, UK
| | - ME Lewis
- Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Trust, Birmingham, UK
| | - TR Graham
- Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Trust, Birmingham, UK,
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Garg N, Soni KD, Aggarwal R. Unstable cardiac injury complicated with septic shock-a challenge. BURNS & TRAUMA 2016; 4:11. [PMID: 27574681 PMCID: PMC4963929 DOI: 10.1186/s41038-016-0035-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 03/25/2016] [Indexed: 11/16/2022]
Abstract
Background Road traffic accident accounts for 70 % to 80 % of the blunt cardiac injury. The true incidence varies in the literature due to non-uniform criteria for diagnosis. Case Presentation Here, we describe the case of a young male presenting after blunt chest injury and hemodynamic instability. Initially, the patient had frequent episodes of arrhythmias and hypotension due to cardiac injury per se. However, he was stabilized by day 2. Subsequently, patient developed cellulitis followed by septic shock and succumbed to cellulitis on day 5 of injury. Conclusion Sepsis is difficult to be diagnosed and treated in the presence of cardiac injury. Myocardial depression has been found in sepsis, which contributes as an added comorbidity in an already compromised heart function. Sepsis also interferes with the diagnosis and follow-up of progress of blunt cardiac injury.
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Affiliation(s)
- Neha Garg
- Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar East, Gautam Nagar, New Delhi, 110029 India
| | - Kapil Dev Soni
- Division of Critical & Intensive care, All India Institute of Medical Sciences, Ansari Nagar East, Gautam Nagar, New Delhi, 110029 India
| | - Richa Aggarwal
- Division of Critical & Intensive care, All India Institute of Medical Sciences, Ansari Nagar East, Gautam Nagar, New Delhi, 110029 India
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Alvarado C, Vargas F, Guzmán F, Zárate A, Correa JL, Ramírez A, Quintero DM, Ramírez EM. Trauma cardiaco cerrado. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2015.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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14
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Bennett BL, Steele P, Dixon CA, Mahabee-Gittens EM, Peebles J, Hart KW, Lindsell CJ, Chua MS, Hirsh R. Serum Cardiac Troponin I in the Evaluation of Nonaccidental Trauma. J Pediatr 2015; 167:669-73.e1. [PMID: 26141552 PMCID: PMC5962961 DOI: 10.1016/j.jpeds.2015.05.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 04/09/2015] [Accepted: 05/21/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine if troponin I is more often elevated in children with suspected nonaccidental trauma (NAT) compared with uninjured children of similar age, and describe associations between troponin I elevation and NAT injuries. STUDY DESIGN Prospective 2-group study of children less than 2 years of age presenting to the emergency department with nonaccidental abdominal, thoracic, or intracranial injuries, and similarly aged uninjured children. Primary outcome was serum troponin I (≥ 0.04 ng/mL) using frozen blood samples from the 2 groups. Secondary outcomes included descriptive analyses of age, injury characteristics, and clinical appearance. RESULTS There were 129 subjects; 60 injured patients and 69 uninjured patients. Groups had similar age and sex. Troponin I was elevated in 38% of injured children compared with 17% of uninjured children (P = .008). No uninjured patient over 3 months of age had elevated troponin I. Abdominal trauma, acute rib fractures, or the child's ill-appearance in the emergency department were associated with having elevated troponin I. CONCLUSIONS Troponin I is more often elevated in children with suspected NAT than uninjured children. Elevation of troponin I in children greater than 3 months of age with suspected NAT is concerning for trauma. Occult cardiac injury is more likely to occur in children with inflicted abdominal trauma, acute rib fractures, or ill appearance.
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Affiliation(s)
- Berkeley L. Bennett
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Paul Steele
- Clinical Laboratory, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Cinnamon A. Dixon
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH,Center for Global Health, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jarrod Peebles
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kimberly W. Hart
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Christopher J. Lindsell
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Michael S. Chua
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Russel Hirsh
- Division of Cardiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
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Hanschen M, Kanz KG, Kirchhoff C, Khalil PN, Wierer M, van Griensven M, Laugwitz KL, Biberthaler P, Lefering R, Huber-Wagner S. Blunt Cardiac Injury in the Severely Injured - A Retrospective Multicentre Study. PLoS One 2015; 10:e0131362. [PMID: 26136126 PMCID: PMC4489656 DOI: 10.1371/journal.pone.0131362] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 06/01/2015] [Indexed: 11/21/2022] Open
Abstract
Background Blunt cardiac injury is a rare trauma entity. Here, we sought to evaluate the relevance and prognostic significance of blunt cardiac injury in severely injured patients. Methods In a retrospective multicentre study, using data collected from 47,580 patients enrolled to TraumaRegister DGU (1993-2009), characteristics of trauma, prehospital / hospital trauma management, and outcome analysis were correlated to the severity of blunt cardiac injury. The severity of cardiac injury was assessed according to the abbreviated injury score (AIS score 1-6), the revised injury severity score (RISC) allowed comparison of expected outcome with injury severity-dependent outcome. N = 1.090 had blunt cardiac trauma (AIS 1-6) (2.3% of patients). Results Predictors of blunt cardiac injury could be identified. Sternal fractures indicate a high risk of the presence of blunt cardiac injury (AIS 0 [control]: 3.0%; AIS 1: 19.3%; AIS 2-6: 19.1%). The overall mortality rate was 13.9%, minor cardiac injury (AIS 1) and severe cardiac injury (AIS 2-6) are associated with higher rates. Severe blunt cardiac injury (AIS 4 and AIS 5-6) is associated with a higher mortality (OR 2.79 and 4.89, respectively) as compared to the predicted average mortality (OR 2.49) of the study collective. Conclusion Multiple injured patients with blunt cardiac trauma are at high risk to be underestimated. Careful evaluation of trauma patients is able to predict the presence of blunt cardiac injury. The severity of blunt cardiac injury needs to be stratified according to the AIS score, as the patients’ outcome is dependent on the severity of cardiac injury.
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Affiliation(s)
- Marc Hanschen
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Karl-Georg Kanz
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Philipe N. Khalil
- Department of General, Visceral-, Transplantation-, Vascular- and Thoracic Surgery—Campus Grosshadern, University Hospital Munich (LMU), Munich, Germany
| | - Matthias Wierer
- Department of General, Visceral-, Transplantation-, Vascular- and Thoracic Surgery—Campus Grosshadern, University Hospital Munich (LMU), Munich, Germany
| | - Martijn van Griensven
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Karl-Ludwig Laugwitz
- I. Medical Department, Cardiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Rolf Lefering
- IFOM–Institute for Research in Operative Medicine, University Witten/Herdecke, Faculty of Health, Cologne, Germany
| | - Stefan Huber-Wagner
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- * E-mail:
| | - TraumaRegister DGU
- Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society (Sektion NIS), Berlin, Germany
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Adissu HA, Medhanie GA, Morikawa L, White JK, Newbigging S, McKerlie C. Right Ventricular Epicardial Fibrosis in Mice With Sternal Segment Dislocation. Vet Pathol 2014; 52:967-76. [PMID: 25281652 DOI: 10.1177/0300985814552108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report coincident sternal segment dislocation and focally extensive right ventricular epicardial fibrosis observed during routine histopathology evaluation of C57BL/6N mice as part of a high throughput phenotyping screen conducted between 4 and 16 weeks of age. This retrospective case series study was conducted to determine whether cardiac fibrosis was a pathological consequence of sternal segment dislocation. We identified sternal segment dislocation in 51 of the total 1103 mice (4.6%) analyzed at 16 weeks of age. Males were more frequently affected. In all cases but 2, the dislocation occurred at the fourth intersternebral joint. In 42 of the 51 cases (82.4%), the dislocation was encased by regenerative cartilaginous callus that protruded internally into the thoracic cavity (intrathoracic callus) and/or externally to the outer aspect of the sternum (extrathoracic callus). Displacement of dislocated ends of the sternum into the thoracic cavity was present in 19 of 51 cases (36.5%). Coincident minimal or mild right ventricular epicardial and subepicardial fibrosis was observed in 22 of the 51 cases (43%) but was not observed in any of the mice in the absence of sternal segment dislocation. Our data suggest that right ventricular fibrosis was likely caused by direct injury of the right ventricle by the dislocated ends of the sternum and/or by intrathoracic callus that develops post dislocation. Potential pathogenesis for the sternal and cardiac lesions and their implication for the interpretation of phenotypes in mouse models of cardiopulmonary and skeletal disease are discussed.
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Affiliation(s)
- H A Adissu
- Centre for Modeling Human Disease, Toronto Centre for Phenogenomics, Toronto, ON, Canada Physiology & Experimental Medicine Research Program, The Hospital for Sick Children, Toronto, ON, Canada Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - G A Medhanie
- Population Medicine, University of Guelph, Ontario Veterinary College, Guelph, ON, Canada
| | - L Morikawa
- Centre for Modeling Human Disease, Toronto Centre for Phenogenomics, Toronto, ON, Canada Physiology & Experimental Medicine Research Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - J K White
- Mouse Genetics Project, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, UK
| | - S Newbigging
- Centre for Modeling Human Disease, Toronto Centre for Phenogenomics, Toronto, ON, Canada Physiology & Experimental Medicine Research Program, The Hospital for Sick Children, Toronto, ON, Canada Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - C McKerlie
- Centre for Modeling Human Disease, Toronto Centre for Phenogenomics, Toronto, ON, Canada Physiology & Experimental Medicine Research Program, The Hospital for Sick Children, Toronto, ON, Canada Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Ocalan K, Solak O, Esme H, Sirmali M, Dilek H, Oz G, Vurmaz A, Karaman A. Efficacy of budesonide and interleukin-10 in an experimental rat model with isolated bilateral pulmonary contusion created by blunt thoracic trauma. Eur J Cardiothorac Surg 2012; 43:163-7. [PMID: 22733840 DOI: 10.1093/ejcts/ezs313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES In our study, we aimed to investigate the anti-inflammatory mediator effects of budesonide (BS), an inhaled corticosteroid and interleukin-10 (IL-10) on a pulmonary contusion in an experimental rat model in which an isolated bilateral pulmonary contusion was created by blunt thoracic trauma. METHODS Fifty-five male Sprague-Dawley rats were used in the study. Sham, control, BS and IL-10 groups were created. A pulmonary contusion was created by performing isolated blunt thoracic trauma in all groups except for the sham group. The trauma's severity was determined as 1.45 J. BS and IL-10 were administered orogastrically to the respective groups 30 min before trauma, and orogastrically and intraperitoneally, respectively, on the first and second days after the trauma. Only the blunt thoracic trauma was performed for the control group. SatO(2), PaO(2) and PaCO(2), blood glutathione, malondialdehyde (MDA) and tumour necrosis factor-α (TNFα) values were recorded on the zeroth, first, second and third days. The histopathological examination and the bronchoalveolar lavage cell count were performed on pulmonary tissues. RESULTS Blood gas analysis revealed that SatO(2) and PaO(2) values on the first and second days were significantly lower in the control, BS and IL-10 groups compared with the sham group (P < 0.05). The SatO(2) and PaO(2) values on the third day in the BS and IL-10 groups were higher than in the control group (P < 0.05). The mean MDA in the control group was higher than in the sham, BS and IL-10 groups (P < 0.05). The mean TNFα in the control group was higher than in the sham, BS and IL-10 groups (P < 0.05). Pulmonary pathology scoring in the control group was observed to be higher than in the sham, BS and IL-10 groups (P < 0.05). CONCLUSION In this rat experiment model in which an isolated pulmonary contusion was created by blunt trauma, BS and IL-10 were observed to reduce contusion severity in the lung and minimize the inflammatory reaction.
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Affiliation(s)
- Kubilay Ocalan
- Department of Thoracic Surgery, School of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
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Du W, Xiong X, Yang W, Wang X, Li T. Dobutamine stress echocardiography assessment of myocardial contusion due to blunt impact in dogs. Cell Biochem Biophys 2011; 62:169-75. [PMID: 21910029 DOI: 10.1007/s12013-011-9278-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We sought to investigate the role of two-dimensional stress echocardiography in the early assessment of myocardial contusion. For this purpose, 12 dogs, weighing 11.36 ± 1.50 kg, were selected and the myocardial contusion was experimentally induced. Two-dimensional dobutamine stress echocardiography (DSE) was used to detect abnormal myocardial motions segments at time phases of baseline and 0.5, 2, 4, and 8 h post-wounding. Finally, the above results were compared with pathological findings. The data show that after the dogs were induced to have severe myocardial contusion, 122 segments were found with abnormal myocardial wall motions at 0.5 h post-wounding, 133 segments at 2 h post-wounding, and 142 segments, each, at 4 h and 8 h post-wounding. The wall motion score (WMS) and wall motion score index (WMSI) increased (P < 0.001) as compared with the pre-impaction values. Considering the left ventricular axis view as the standard section, in the 60 segments examined by echocardiography, 54 segments were found to have wall motion abnormalities. Comparing with the results of pathological TTC staining, the sensitivity and specificity were found to be 100 and 66.6%, respectively. It was, therefore, concluded that two-dimensional DSE was a valuable technique in the early diagnosis of myocardial contusion due to its better sensitivity and specificity.
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Affiliation(s)
- WenHua Du
- Department of Ultrasound, Daping Hospital & Research Institute of Surgery, The Military Medical University, Chongqing, China
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Blunt cardiac injury in trauma patients with thoracic aortic injury. Emerg Med Int 2011; 2011:848013. [PMID: 22046549 PMCID: PMC3200124 DOI: 10.1155/2011/848013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 05/10/2011] [Indexed: 11/27/2022] Open
Abstract
Trauma patients with thoracic aortic injury (TAI) suffer blunt cardiac injury (BCI) at variable frequencies. This investigation aimed to determine the frequency of BCI in trauma patients with TAI and compare with those without TAI. All trauma patients with TAI who had admission electrocardiography (ECG) and serum creatine kinase-MB (CK-MB) from January 1999 to May 2009 were included as a study group at a level I trauma center. BCI was diagnosed if there was a positive ECG with either an elevated CK-MB or abnormal echocardiography. There were 26 patients (19 men, mean age 45.1 years, mean ISS 34.4) in the study group; 20 had evidence of BCI. Of 52 patients in the control group (38 men, mean age 46.9 years, mean ISS 38.7), eighteen had evidence of BCI. There was a significantly higher rate of BCI in trauma patients with TAI versus those without TAI (77% versus 35%, P < 0.001).
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McCunn M, Gordon EKB, Scott TH. Anesthetic concerns in trauma victims requiring operative intervention: the patient too sick to anesthetize. Anesthesiol Clin 2010; 28:97-116. [PMID: 20400043 DOI: 10.1016/j.anclin.2010.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Trauma is the third leading cause of death in the U.S. Timely acute care anesthetic management of patients following traumatic injury may improve outcome. Recognition of highly-mortal injuries to the brain, heart, lungs, liver, and pelvis should guide trauma-specific management strategies. Rapid intraoperative treatment of life-threatening conditions following injury includes the use of 'controlled-under resuscitation' of fluid administration until surgical hemorrhage control, early factor replacement in addition to transfusion of packed red blood cells, and use of adjuvant therapies such as recombinant factor VIIa. These treatment strategies, other recent developments in acute trauma resuscitation, and a review of associated co-existing medical conditions that may impact mortality, are presented.
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Affiliation(s)
- Maureen McCunn
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Dulles 6, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Left cardiac luxation caused by a blunt chest trauma: a difficult diagnosis confirmed on chest computed tomography scan-two case reports. ACTA ACUST UNITED AC 2010; 68:E74-6. [PMID: 20220406 DOI: 10.1097/ta.0b013e318166d2a9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Assessment of cardiac injury in patients with blunt chest trauma. Eur J Trauma Emerg Surg 2010; 36:441-7. [DOI: 10.1007/s00068-010-0005-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 10/21/2009] [Indexed: 11/26/2022]
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24
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Agarwal D, Chandra S. Challenges in the diagnosis of blunt cardiac injuries. Indian J Surg 2009; 71:245-53. [PMID: 23133167 DOI: 10.1007/s12262-009-0078-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 07/14/2009] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Blunt thoracic injuries (BTIs) are directly responsible for 20-25% of all deaths, worldwide. Involvement of heart in BTIs is largely underestimated and ignored, but reasonable estimate would be around 15%. This study was planned to emphasize on clinical-presentation and diagnosis of blunt cardiac injuries (BCIs). RESULTS Clinical presentation of BCIs, varied from mild chest discomfort to haemodynamic shock secondary to rapid exsanguinations. Non-specific presentation with associated injuries diverts physician's attention and delayed appearance of clinical features makes diagnosis further difficult. Cardiac markers and ECG are not specific, but high sensitivity of 100% could be reached using combination of elevated cardiactroponin levels and alterations in ECG. Transoesophageal or transthoracic echocardiography, angiography, intravascular ultrasound and nuclear scan have proven to detect cardiac injuries in BTIs, but lack specificity. CONCLUSION Patients with suspicious-ECG finding need cardiac-monitoring for at least 24 hours. Haemodynamically stable young (<55 years) subjects, without underlying cardiac diseases and with normal-ECG and cardiac marker, could be discharged safely.
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25
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El-Chami MF, Nicholson W, Helmy T. Blunt Cardiac Trauma. J Emerg Med 2008; 35:127-33. [DOI: 10.1016/j.jemermed.2007.03.018] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Revised: 05/16/2006] [Accepted: 10/02/2006] [Indexed: 10/23/2022]
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26
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Stein DM, Scalea TM. Trauma to the Torso. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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Affiliation(s)
- Roberto Fumagalli
- Faculty of Medicine, Università degli Studi Milano-Bicocca (R.F.), Milano, Italy
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Bansal MK, Maraj S, Chewaproug D, Amanullah A. Myocardial contusion injury: redefining the diagnostic algorithm. Emerg Med J 2005; 22:465-9. [PMID: 15983078 PMCID: PMC1726836 DOI: 10.1136/emj.2004.015339] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Myocardial contusion injury (MCI) is a complication of blunt thoracic trauma, which may occur at relatively low velocities. MCI may also occur from chest compressions during cardiopulmonary resuscitation. We review the clinical pathology, diagnostic tools, and treatment for MCI.
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Affiliation(s)
- M K Bansal
- Division of Cardiology, Albert Einstein Medical Center, 5401 Old York Rd, HB #3, Philadelphia, PA 19141, USA.
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29
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Abstract
In summary, the incidence of BCI following blunt thoracic trauma patients has been reported between 20% and 76%, and no gold standard exists to diagnose BCI. Diagnostic tests should be limited to identify those patients who are at risk of developing cardiac complications as a result of BCI. Therapeutic interventions should be directed to treat the complications of BCI. Finally, the prognosis and outcome of BCI patients is encouraging
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Affiliation(s)
- Jess M Schultz
- Department of Surgery, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, L223, Portland, OR 97239, USA
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30
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Wang ND, Stevens MH, Doty DB, Hammond EH. Blunt chest trauma: an experimental model for heart and lung contusion. THE JOURNAL OF TRAUMA 2003; 54:744-8. [PMID: 12707538 DOI: 10.1097/01.ta.0000052362.40754.f2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Blunt chest trauma is an important clinical problem leading to injury of the heart and lungs that may be fatal. Experimental models in large animals have been developed previously. This study was aimed at developing a small-animal (rat) model for the purpose of evaluating blunt chest trauma. METHODS Blunt trauma was delivered to the left side of the chest in rats by a captive bolt handgun. The gun was modified so that the amount of energy delivered to the chest wall could be adjusted. The injury energy varied from 1.7 to 6.8 J. Thirty-eight experiments in adult rats were performed. Electrocardiographic monitoring was performed continuously to determine cardiac rhythm. Gross and histologic examination of lungs and heart was performed at the time of death resulting from injury or euthanasia up to 13 days after injury. RESULTS Some form of cardiac arrhythmia accompanied blunt chest trauma in every case. Serious ventricular arrhythmia (tachycardia or fibrillation) was nearly always fatal (15 of 16 cases), but gross or histologic evidence of cardiac injury was present in only 31% of fatal cases. Lung injury (often bilateral) as shown by atelectasis and hemorrhage into the parenchyma or airway was found in 93% of the experiments when medium range energy force was applied. CONCLUSION This study has established a useful model for the study of blunt chest trauma in a small animal (rat). Blunt chest trauma is associated with cardiac arrhythmia, which may be fatal. Injury to the heart may not correlate with serious cardiac arrhythmia resulting in death, lending credence to the concept of cardiac concussion or commotio cordis. Lung contusion is always more obvious than morphologic injury to the heart.
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Affiliation(s)
- Nai-dong Wang
- Department of Surgery, LDS Hospital, Salt Lake City, Utah, USA
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Lancey RA, Monahan TS. Correlation of clinical characteristics and outcomes with injury scoring in blunt cardiac trauma. THE JOURNAL OF TRAUMA 2003; 54:509-15. [PMID: 12634531 DOI: 10.1097/01.ta.0000025312.48962.c5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinical sequelae from blunt cardiac trauma (BCT) may range from minor electrocardiographic abnormalities to death from free-wall rupture. There are no established clinical characteristics or injury scoring systems that are able to predict survival in these patients. METHODS A retrospective review of medical records from a Level I trauma center identified 47 patients with BCT. A grade assigned on the basis of the American Association for the Surgery of Trauma Organ Injury Scale (OIS) was assigned to each case studied. Clinical data, including the Injury Severity Score (ISS), and outcomes were analyzed for association with OIS grade. RESULTS The average ISS was 27.9, and the overall mortality rate was 31.9%. The majority of patients were either grade II or IV, with the latter having the highest mortality. Hypotension at admission, cardiac arrest, lack of vital signs at admission, ISS, hours to diagnosis, and death all had significant association with assigned OIS grade. Factors associated with mortality included ISS; OIS grade; shorter time to diagnosis; cardiac tamponade; cardiac rupture; lack of vital signs at admission; and concomitant injury to either the thoracic aorta or to the liver, spleen, or kidneys. CONCLUSION The OIS grade, assigned on the basis of anatomic site of injury and electrocardiographic abnormalities, appears to correlate with severity of injury and survival. Although injury scoring should not be used exclusively to guide management in trauma patients, the grading system studied may be useful in predicting outcomes in patients with BCT.
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Affiliation(s)
- Robert A Lancey
- Department of Surgery, University of MAssachusetts Medical School, UMass Memorial Medical Center, Worcester, 01655, USA.
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Hill G, Davies K. Blunt chest trauma: a challenge to accident and emergency nurses. ACCIDENT AND EMERGENCY NURSING 2002; 10:197-204. [PMID: 12568446 DOI: 10.1016/s0965-2302(02)00126-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Gaynor Hill
- Sister Coronary Care Unit, Prince Charles Hospital, Merthyr Tydfil, CF47 9DT, UK
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Salim A, Velmahos GC, Jindal A, Chan L, Vassiliu P, Belzberg H, Asensio J, Demetriades D. Clinically significant blunt cardiac trauma: role of serum troponin levels combined with electrocardiographic findings. THE JOURNAL OF TRAUMA 2001; 50:237-43. [PMID: 11242287 DOI: 10.1097/00005373-200102000-00008] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The true importance of blunt cardiac trauma (BCT) is related to the cardiac complications arising from it. Diagnostic tests that can predict accurately if such complications will develop or not may allow early and aggressive monitoring or early discharge. We investigated the role of two simple and convenient tests, serum cardiac troponin I (cTnI) and electrocardiogram (ECG), when used to identify patients at risk of cardiac complications after BCT. METHODS Over a 10-month period, 115 patients with evidence of significant blunt thoracic trauma were prospectively followed to identify the presence of clinically significant BCT (Sig-BCT), defined as cardiogenic shock, arrhythmias requiring treatment, or structural cardiac abnormalities directly related to the cardiac trauma. An ECG was obtained at admission and at 8 hours. Cardiac troponin I was measured at admission, at 4 hours, and at 8 hours. Transthoracic echocardiography was performed when clinically indicated. The sensitivity, specificity, and positive and negative predictive values of ECG and cTnI to identify Sig-BCT were calculated. Clinical risk factors for Sig-BCT were examined by univariate and multivariate analysis. RESULTS Nineteen patients (16.5%) were diagnosed with Sig-BCT and, in 18 of them, symptoms presented within 24 hours of admission. Abnormal electrocardiographic findings were detected in 58 patients (50%) and elevated cTnI levels in 27 (23.5%). Electrocardiography and cTnI had positive predictive values of 28% and 48% and negative predictive values of 95% and 93%, respectively. However, when both tests were abnormal (positive) or normal (negative), the positive and negative predictive values increased to 62% and 100%, respectively. Other independent risk factors for Sig-BCT were head injury, spinal injury, history of preexisting cardiac disease, and a chest Abbreviated Injury Score greater than 2. CONCLUSION The combination of ECG and cTnI identifies reliably the presence or absence of Sig-BCT. Patients with an abnormal ECG and cTnI need close monitoring for at least 24 hours. Patients with a normal admission ECG and cTnI can be safely discharged in the absence of other injuries.
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Affiliation(s)
- A Salim
- Department of Surgery, Division of Trauma and Critical Care, Keck School of Medicine, LAC+USC Medical Center, 1200 N. State Street, Room 9900, Los Angeles, CA 90033, USA.
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Welch RD. Management of traumatically injured patients in the emergency department observation unit. Emerg Med Clin North Am 2001; 19:137-54. [PMID: 11214395 DOI: 10.1016/s0733-8627(05)70172-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An EDOU may be an ideal setting for the short-term monitoring and treatment of certain acutely injured patients. The patients choosen for observation, and the diagnostic studies used, will be specific to a particular institution's availability and expertise. Pathways should be developed in conjunction with all services caring for these patients.
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Affiliation(s)
- R D Welch
- Department of Emergency Medicine, Wayne State University School of Medicine, Detriot, Michigan, USA.
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Abstract
The evaluation of mediastinal trauma has undergone some important changes in the last few years. Electrocardiography (ECG) combined with troponin measurements have become the standard of evaluation of suspected blunt cardiac trauma. Spiral computerized tomography (CT) scan has largely replaced angiography for suspected blunt aortic rupture. There is good evidence that with a suspicious mechanism of injury the thoracic aorta should be evaluated irrespective of chest X-ray findings. In penetrating trauma the introduction of trauma ultrasound in the emergency room has revolutionized the early diagnosis of cardiac tamponade. Most mediastinal gunshot wounds in haemodynamically stable patients can safely be managed non-operatively. Evaluation of the direction of the bullet tract by means of spiral CT scan has replaced angiography and oesophageal studies in about 75% of patients with mediastinal gunshot wounds who are haemodynamically stable.
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Affiliation(s)
- Ali Salim
- Department of Surgery, Division of Trauma and Critical Care, University of Southern California School of Medicine and the Los Angeles County and University of Southern California Medical Center, Los Angeles, CA 90033, USA
| | - Demetrios Demetriades
- Department of Surgery, Division of Trauma and Critical Care, University of Southern California School of Medicine and the Los Angeles County and University of Southern California Medical Center, Los Angeles, CA 90033, USA,
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Banzo I, Montero A, Uriarte I, Vallina N, Hernández A, Guede C, Quirce R, Carril JM. Coronary artery occlusion and myocardial infarction: a seldom encountered complication of blunt chest trauma. Clin Nucl Med 1999; 24:94-6. [PMID: 9988064 DOI: 10.1097/00003072-199902000-00003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Myocardial infarction is a rare complication that can occur after blunt chest trauma. The authors describe a 30-year-old man who experienced a fatal anterolateral myocardial infarction after chest trauma in a motorcycle accident. The electrocardiogram and creatine phosphokinase-MB isoenzymes levels suggested myocardial necrosis. Tc-99m phosphate myocardial scintigraphy identified an extensive doughnut-shaped uptake over the cardiac area. An echocardiogram revealed severe left ventricular impairment. Coronary angiography confirmed complete occlusion of the proximal left anterior descending coronary artery.
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Affiliation(s)
- I Banzo
- Nuclear Medicine Service, University Hospital Marqués de Valdecilla, Santander, Spain
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Affiliation(s)
- A T Pezzella
- Department of Surgery, University of Massachusetts Medical Center, Worcester, USA
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Keough V, Letizia M. Blunt cardiac injury in the elderly trauma patient. INTERNATIONAL JOURNAL OF TRAUMA NURSING 1998; 4:38-43. [PMID: 9855964 DOI: 10.1016/s1075-4210(98)90045-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Elderly patients are at significant risk for development of complications after a traumatic event as a result of the aging process. This case discusses the diagnosis and sequelae of blunt cardiac injury, as well as the needs and approaches for an elderly patient. Nursing care interventions are provided.
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Affiliation(s)
- V Keough
- Loyola University School of Nursing, Maywood, IL 60153, USA
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Dodd KT, Mundie TG, Lagutchik MS, Morris JR. Cardiopulmonary effects of high-impulse noise exposure. THE JOURNAL OF TRAUMA 1997; 43:656-66. [PMID: 9356064 DOI: 10.1097/00005373-199710000-00016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In high-energy impulse noise environments, the biomechanical coupling process between the external forces and the pathophysiology of cardiopulmonary injury is not well understood. A 12-in-diameter compressed air-driven shock tube with reflector plate was used to induce three levels of pulmonary contusion injury in a large animal model. Twenty-one anesthetized sheep were exposed to the various levels of impulse noise generated by the shock tube, with six additional sheep serving as a control group. Pathologic evaluations, performed 3 hours after exposure, showed pulmonary contusion ranging from minor petechial changes on the surface of the lung parenchyma to diffuse ecchymoses affecting as much as 60% of the lung. The gross pathologic observations of injury produced by exposure to the impulse noise produced by the shock tube were similar to those reported for blunt impact trauma or exposure to chemical or grain-dust explosions. The extent of lung injury (lung injury index) was quantitatively assessed. A semilogarithmic relationship between the lung injury index and the measured peak pressure was demonstrated. A significant linear correlation was demonstrated between lung injury index and lung weight-to-body weight ratio. Significant cardiopulmonary changes were also observed as a result of exposure to high-impulse noise. Although in most cases the degree of change was related to the severity of the injury, significant cardiopulmonary function changes were also observed in the absence of significant grossly observable pulmonary injury. Cardiac injury was indicated by decreased cardiac output and hypotension at all levels of injury and might be the result of myocardial contusion or air emboli. Pulmonary injury was demonstrated by respiratory acidosis, increases in lung resistance, and decreases in lung compliance and lung volume. Arterial PO2 appeared to be the most sensitive parameter of injury and was decreased for all measurement intervals for all exposure groups.
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Affiliation(s)
- K T Dodd
- Department of Respiratory Research, Walter Reed Army Institute of Research, Washington, DC, USA
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Hoppe UC, Erdmann E. [Contusio cordis--too seldom diagnosed?]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 1997; 92:444-6. [PMID: 9324632 DOI: 10.1007/bf03042578] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Myocardial contusion is the most common injury caused by blunt chest trauma. Cardiac contusion often does not produce significant symptoms and, thus, remains unrecognized. CASE REPORT A 29-year-old professional ice-hockey player presented with a tachyarrhythmia two days after having suffered a thoracic trauma. Two weeks prior to admission he had an influenza-like infection. Non-invasive diagnostic methods were normal. However, cardiac catheterization revealed an akinesis of the left ventricular anterior wall in the absence of any coronary artery lesions. Endomyocardial biopsy did not show any evidence of myocarditis but erythrocyte extravasations in the endo- and myocardium, thus, confirming the diagnosis of cardiac contusion. Three months later, left ventriculography and coronary angiography did neither demonstrate any abnormalities of ventricular contraction nor of the coronary vessels. CONCLUSION Myocardial contusion is still being rarely diagnosed after sporting accidents. Cardiac contusion is a benign disorder in most patients. However, due to its potentially lethal outcome and as sequelae may present late after the trauma, early and precise diagnosis is important, both from the clinical point of view as well as for future insurance requests. Thus, invasive diagnostic techniques should be performed when non-invasive examinations do not provide a conclusive diagnosis.
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Affiliation(s)
- U C Hoppe
- Klinik III für Innere Medizin, Universität zu Köln
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Abstract
New clinical requirements for triaging chest pain patients challenge the abilities of the current cardiac markers. Serial measurements of myoglobin, creatine kinase (CK) isoenzyme MB (CKMB) mass, or CK isoforms in emergency rooms help to rapidly rule out acute myocardial infarction (AMI). However, within the first 3 to 4 h from chest pain onset, their sensitivities are too low to contribute significantly to AMI diagnosis during this period. CKMB and lactate dehydrogenase (LDH) isoenzyme 1 are not heart-specific, which hampers reliable diagnosis in patients with concomitant skeletal muscle damage. By contrast, the regulatory proteins troponin I and troponin T are expressed in three different isoforms: one for slow-twitch skeletal muscle fibers, one for fast-twitch skeletal muscle fibers, and one for cardiac muscle (cTnI, cTnT); cardiac-specific cTnI and cTnT assays are already available for routine use. cTnT and cTnI are the most promising markers for risk stratification in patients with unstable angina pectoris. Recent reports on increased cTnT in patients with renal failure or myopathy without evidence of myocardial injury and undetectable cTnI suggest that cTnT could be reexpressed similar to CKMB and LDH-1 in chronically damaged human skeletal muscle. Therefore, cTnI is probably the most heart-specific marker. Among the recently proposed new markers for early AMI diagnosis: glycogen phosphorylase isoenzyme BB (GPBB), fatty acid binding protein, phosphoglyceric acid mutase isoenzyme MB, enolase isoenzyme alpha beta, S100a0, and annexin V, GPBB is the most promising because it increases as early as 1 to 4 h from chest pain onset and its early release appears to be essentially dependent on ischemic myocardial injury.
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Affiliation(s)
- J Mair
- Institut für Medizinische Chemie and Biochemie, University of Innsbruck, Austria.
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