Cardiac Trauma

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Transcript

Welcome to the final lecture of course, cardiac trauma. Cardiac trauma is something you'll be dealing with frequently if you're an emergency physician. And echocardiography is the initial imaging method of choice in the assessment, or electronic can be blunt, as in motor vehicle accidents and falls from height, or penetrating trauma as in stabs and gunshot wounds, both can cause the same kind of damage with a few minor differences that we'll mention. In this lecture, you'll learn what to look for in emergency echocardiography assessment of a cardiac trauma patient chart of the heart can affect the pericardium. The myocardium heart valves are the great vessels and we'll cover them one by one. In case of the pericardium you'll expect to see hemorrhagic pericardial effusion and if the amount or rate of bleeding is enough, Tampax obviously this is this is an example of hemorrhagic temper.

This is a chronic pericardial effusion as you can see by a large amount of effusion along the pericardium a stretch, but it's here just for demonstration of template anyway, the tear can involve one or both layers of the pericardium and in the ladder, the hemorrhage will extend to the media style, causing chemo media style. blunt trauma to the ventricles or atria can be mild and only cause my cardio contusions which are difficult to detect reliably by any modality. And in any case, the diagnosis doesn't change management much. But if the trauma is more severe, however, tear of the myocardium into the pericardium, or all the way into the mediastinum can occur, leading to again hemorrhagic effusion of the champion out in the first case or to hemo Media Steinem with massive blood loss in the second myocardial tears due to penetrating trauma usually affect the RV being the most anterior structure and carry a much better prognosis then, one trauma tears because the wound is usually smaller and more regular, so less blood loss occurs.

By echocardiography all you can usually see the fusion but in some cases, you can actually visualize the defect and the blood escaping through to the heart valves typically causes acute regurgitation of varying degrees up to severe irritation with valves leaflets. trauma to the vessels can cause rupture of the aorta or when you come in with human designer, Eric rupture usually portends a grave prognosis, and most patients die before reaching the hospital, so you're not likely to get a chance to look at any of them using echo. What you might see is traumatic aortic dissection, which looks pretty much like spontaneous order dissection that we discussed in lecture 17. Rarely traumatic rupture, dissection or thrombosis of the coronary arteries may occur, leading to myocardial infarction and regional wall motion abnormalities on echo with or without systolic dysfunction. In the case of gunshot wounds, you'll also be required to report whether you can see bullet fragments or shrapnel lodged in the myocardium because they would need surgical extraction.

Those will appear as bright methods within the myocardium which cast acoustic shadow similar to prosthetic valves. Now you know what to look for in a cardiac trauma patient. The order of examination is the same as usual. That way you don't forget anything. That brings us to the end of this lecture. See you in the next lecture where you're going to learn to put together everything you've learned and perform your first complete echocardiography examination.

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