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Cardiovascular Trauma

Cardiovascular Trauma

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Cardiovascular Trauma

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  1. Cardiovascular Trauma Syed T Zaidi

  2. Cardiovascular Trauma • Trauma: 4th leading cause of death in US. • CV Trauma: Exact incidence is Unknown. • Penetrating: 6% of 1200 were alive. • Males (15 – 35)

  3. 50% die rapidly before arival. • Chambers mostly involved: RV LV RA LA

  4. Car antenna

  5. Right ventricular stab - knife in situ

  6. Right ventricular stab - knife in situ

  7. Left chest impalement

  8. Penetrating cardiac injury - stab to precordium

  9. Retroaorticbullet

  10. Chamber penetrated • Pericardial involvement.

  11. Blunt Cardiac Injury. • Direct: • Indirect: Pressure on Abdomen. Automobile Accidents.

  12. Myocardial Contusions • Histologic diagnosis. • No definitive clinical criterias. • Arrythmias/ Heartfailure/ Sudden death. • Coronory arteries: Occlusion, laceration , fistuala • IV septal rupture, Myocardial Aneurysm or Pseudoaneurysm • Atleast 24 hour EKG monitoring in stable pts.

  13. Chamber or Vessel laceration. cardiac trauma-chamber rupture

  14. Injury to Aorta • Rupture of Arota • 8000 cases/year in USA • Rapid deceleration injury. • 20% pts who die of MVA. • 80 -90% fatal • Location • Partial rupture • Pseudoaneurysm • Fistulas. • TEE/CT

  15. Aortic arch injury-psuedoaneurysm

  16. Papillary Muscle Rupture

  17. Iatrogenic Injury • CPR Rib fx  LV/RV rupture. • Rupture of • pappilary muscles • Aorta • Penetrating : • RV biopsy • Pacemakerwires.

  18. Iatrogenic Injury • Coronory Angio/PTCA • Arota or coronory ostial dissections • Coronory artery rupture. • IABP • Dissection • Thromboemboli. • Indwelling venous catheters/Swans. • Pulmonary artery perforations.

  19. Diagnosis. • Index of suspicion. • Absence of visible injuries • Absence of enzyme leak • ABCD/Signs of Tamponade/Shock • EKG • Enzymes • Echo/TEE

  20. Signs of Tamponade • Hypotension • Pulsus Paradoxus • kussmaul's sign

  21. Diagnosis.

  22. Treatment • Emergency pericardiocentesis • Emergency ThoracotomySevere Hemorrhage. • Conservative managementContusions. • Fluid resuscitation. • Ionotrpic agents/IABP. • Surgery • Rupture • Septum • Chambers • Pseudoaneurysm

  23. END