Cardiac Injury, Blunt Trauma

Unforeseen

Step 1: View clinicals

A 63-year-old man presents with worsening dyspnea for one day. Further questioning reveals that he has been 'feeling ill' since four days ago. Eight days earlier, he fell off of a ladder and fractured two ribs on his right side. X-rays at the emergency department showed no evidence of pneumothorax, and he was subsequently sent home on analgesics. An urgent ECG is found to be normal.


Step 2: Order all relevant investigations

Portable chest X-ray

The films show healing rib fractures with no consolidation, pneumothorax or hemothorax.

FAST scan

You remember that FAST scanning is indicated for the evaluation of acute trauma.

Portable echocardiography

A moderate to severe pericardial effusion is seen with a fluid rim of approximately 2cm around the entire pericardium.

CT Thorax

You realize that the patient is hemodynamically unstable, and thus unsuitable for CT imaging right now.


Step 3: Select appropriate management

IV vasopressors
IV fluids stat
Intercostal tube placement
Ultrasound-guided drainage


Score: ★★☆