Topics covered include managing the patient with sepsis or septic shock; anesthetic considerations for patients in respiratory failure; anesthetic concerns in patients presenting with renal failure; perioperative management of patients with liver failure [books.google.de]

Cardiac rupture from blunt chest trauma is not a common presentation, and more so in the absence of rib or sternal fracture. We present a case of blunt chest trauma, who presented with features of cardiac tamponade. [jctt.org]

Visualization based on CT scan acquisition are presented combined with the results of macroscopic and microscopic examination. [paperity.org]

Hemopericardium or pericardial tamponade is the usual clinical presentation, and surgery is almost always necessary. [health.am]

Typically, patients present with hypovolemic shock and signs of peritonitis. [abdominalsurg.org]

• Pain

  An aneurysm doesn't explain her joint pain. Would it surprise you to learn it was an aneurysm? As a result- violations of cerebral blood flow, aneurysm, neurosis, cardiovascular pathology. [tr-ex.me]

  When present, symptoms of an aortic rupture may include: Severe chest pain Severe back pain Severe abdominal pain Signs of external chest injury Causes and Risk Factors The condition is caused by trauma to the aorta. [cedars-sinai.edu]

  The most common signs of significant abdominal trauma are pain, gastrointestinal hemorrhage, hypovolemia, and peritoneal irritation. [amboss.com]

  CASE 1 A 54-year-old male presented with acute onset of pain abdominal pain since one day in the left quadrant. He experienced nausea. No fever was reported. [abdominalsurg.org]

  If the aneurysm is pressing against nearby tissues, patients may notice a deep, steady pain in the back, abdomen or groin. Abdominal aortic aneurysms may also cause a pulsing sensation in the abdomen. [uwhealth.org]

• Collapse

  The main echocardiographic sign of cardiac tamponade is heart collapse. [acls.com]

  The focus is on managing the compromised airway, followed by managing pulmonary pathology and circulatory collapse. [ahcmedia.com]

  It can detect whether the pericardium is distended and if the ventricles have collapsed due to low blood volume. Your chest X-rays may show an enlarged, globe-shaped heart if you have cardiac tamponade. [healthline.com]

  Associated injuries include haemopneumothoraces, pulmonary contusions, lower lobe collapse/atelectasis/consolidation, surgical emphysema, rib/clavicle/sternal and thoracic spine fractures [ 13 – 15 ]. [sjtrem.biomedcentral.com]

  By far the most dramatic is rupture of the free wall of the left or right ventricles, as this is associated with immediate hemodynamic collapse and death secondary to acute pericardial tamponade. [en.wikipedia.org]

• Congestive Heart Failure

  […] impulses that control the heartbeat congestive heart failure, a condition in which the heart's decreased pumping ability causes fluid to back up into the lungs damage to heart valves death of areas of heart muscle rupture of the heart chamber walls and [medicineonline.com]

  These entities generally present with clinically significant acute congestive heart failure. Another rare entity is pericardial rupture with cardiac herniation. [intechopen.com]

  This situation may appear as a wide variety of disorders such as life-threatening arrhythmias, anomalies of conduction system, congestive heart failure, cardiogenic shock, hemopericardium, pericardial tamponade, cardiac rupture, valvular rupture, intraventricular [ispub.com]

• Aspiration

  The blinded method, however, may be associated with misleading results up to 25% of the time, with false positives from aspirating blood from the cardiac chamber and false negatives from the immediate clotting of aspirated blood from a rapidly bleeding [ahcmedia.com]

  FAST can be combined with aspiration of the free fluid when the fluid is easy accessible to determine the type of fluid. [abdominalsurg.org]

  According to Hirai et al ., the color of blood aspirated on paracentesis gives a clue regarding the site of BCI. [9] Figueiredo et al. were able to diagnose tamponade in the absence of USG, on clinical suspicion, radiography and subxiphoid pericardial [jctt.org]

• Heart Disease

  Commotio cordis is sudden cardiac arrest that follows a blow to the anterior chest wall in patients who do not have pre-existing or traumatic structural heart disease. [merckmanuals.com]

  Traumatic heart disease, in: zipes DP, Libby P, Bonow RO, Braunwald E, editors: braunwald's heart disease: a textbook of cardiovascular medicine. 7 th ed Philadelphia: Elsevier Saunders. 2005; 7: 1781-8. Google Scholar Guo H, Chi J, Yuan M, Qiu Y. [panafrican-med-journal.com]

  And long-term emotional stress shortens lives by increasing the risk of heart disease, notes Daniel J. Brotman, MD, director of the hospitalist program at Johns Hopkins Hospital, Baltimore. [webmd.com]

  […] in which the immune system mistakenly attacks healthy tissues high levels of radiation to the chest hypothyroidism, which increases the risk for heart disease a heart attack kidney failure infections that affect the heart Cardiac tamponade has the following [healthline.com]

  Attribution Author: Eric Berlin, MD Date Written: Editor: Ballenberg, Sally, BS Edit Date: 08/31/01 Reviewer: Eileen McLaughlin, RN, BSN Date Reviewed: 07/31/01 Sources Merck Manual 1999 Harrison's Principles of Internal Medicine 1991 Heart Disease: A [medicineonline.com]

• Heart Block

  Recurrent syncope may be reported in someone with tamponade or heart block after cardiac trauma. [tele.med.ru]

  block or ischaemic changes without cardiac failure 3 Penetrating tangential cardiac wound up to but not extending through endocardium, without tamponade 3-4 III Blunt cardiac injury with sustained or multifocal ventricular contractions 3-4 Blunt or penetrating [trauma.org]

  block or ischemic changes without cardiac failure Penetrating tangential cardiac wound, up to but not extending through endocardium, without tamponade Grade III Blunt cardiac injury with sustained or multifocal ventricular contracations Blunt or penetrating [aast.org]

  The electrocardiogram showed advanced heart block with mean heart rate of 30 bpm. She was not under any negative chronotropic medication and laboratory tests showed no relevant electrolyte disturbances. [elsevier.pt]

  Any arrhythmia may be detected after BCI including sinus tachycardia, supraventricular arrhythmias, ventricular arrhythmias, any type of heart block, ST-T changes or Q waves [ 13 ]. [intechopen.com]

• Fear

  Acute fear, grief, startling, or anger can cause "stunned heart." Wallops of emotion also can cause sudden death due to life-threatening abnormal heart rhythm. [webmd.com]

  Also, significant arrhythmia and stress-induced cardiomyopathy (Takotsubo cardiomyopathy) have been reported in many cases secondary to the fear and stress of trauma. [13], [14] Blunt aortic injury Blunt aortic injury (BAI) is a common cause of traumatic [annals.in]

• Confusion

  However, he is now awake but confused and agitated. "The patient has slightly elevated blood pressure, facial cuts and blood in both nostrils. Breathing okay, lungs are clear. No obvious damage to the abdomen," the EMTs radio. [thedoctorwillseeyounow.com]

  Whereas LA rupture is uncommon and is the less expected cause of a wide mediastinum following blunt chest trauma, it can easily be confused with thoracic aortic injury. [onlinejets.org]

  Because of the setting in which the diagnosis of cardiac trauma is considered, it is unlikely to be confused with other entities. Therefore, diagnostic problems revolve around identifying specific lesions that result from the traumatic event. [tele.med.ru]

  A meta-analysis of blunt cardiac trauma: ending myocardial confusion. Am J Emerg Med. 1996; 14 (3): 237-41[ DOI ][ PubMed ] 36. Rozycki GS, Feliciano DV, Ochsner MG, Knudson MM, Hoyt DB, Davis F, et al. [traumamon.com]

  You can manage this and all other alerts in My Account The alert will be sent to: × Top DIAGNOSIS of lesions of the heart related to blunt trauma is a challenge, mainly because of confusion about the terms used and the absence of recognized standards. [anesthesiology.pubs.asahq.org]

The authors concluded that a cTnI greater than 1.05 µg/L necessitated further workup. Neither CK total or CK-MB were helpful in predicting BCI. [east.org]

There are no pathognomonic findings; however, the presence of a new arrhythmia is a sign that workup needs to be escalated. [intechopen.com]

Radiologic workup revealed a bilateral pleural effusion, a fracture of the right collarbone, a hepatic contusion, a right adrenal hematoma and a fracture of the left iliac wing. [panafrican-med-journal.com]

While the majority of cases require little workup, it is crucial to identify those cases that warrant more extensive evaluation. Cases of life-threatening BCI, while rare, require urgent stabilization. [ahcmedia.com]

• Pericardial Effusion

  Echocardiography evaluates wall motions, valvular function and ejection fraction and determines diagnoses of pleural-pericardial effusions and aortic injury. Our patient had pericardial effusion. [casereports.in]

  Echocardiography is the main diagnostic method for detection of pericardial effusion and tamponade 4. [acls.com]

  Summary echocardiography revealed mild systolic dysfunction without pericardial effusion. [elsevier.pt]

  Probe Position for Parasternal Long View of Pericardial Effusion Figure 2. Parasternal Long View of Pericardial Effusion Figure 3. Probe Position for Subxiphoid View of Pericardial Effusion Parasternal long view of pericardial effusion. [ahcmedia.com]

  A focal posterior effusion, seen on the parasternal long axis view, may be a left pleural effusion rather than a pericardial effusion. The hypoechoic stripe of a pericardial effusion usually wraps around the apex of the heart. [acep.org]

• Atelectasis

  […] trauma Chest wall injury Etiology : mostly blunt trauma, pathologic fractures, nonaccidental trauma ( child abuse ) Clinical features Diagnostics Complications Pneumothorax Hemothorax Especially in the elderly: pain → splinting and hypoventilation → atelectasis [amboss.com]

  Associated injuries include haemopneumothoraces, pulmonary contusions, lower lobe collapse/atelectasis/consolidation, surgical emphysema, rib/clavicle/sternal and thoracic spine fractures [ 13 – 15 ]. [sjtrem.biomedcentral.com]

• ST Elevation

  Changes in Hospital Mortality Rates in 425 Patients with Acute ST-Elevation Myocardial Infarction and Cardiac Rupure Over a 30-Year Period. Circulation. 2008;118:2783–9. ^ a b Lin TH, Su HM, Voon WC, Lai HM, Yen HW, Lai WT, Sheu SH (2006). [en.wikipedia.org]

  Initial assessment showed an ST segment elevation on ECG, along with multiple fractures and abdominal injuries. [panafrican-med-journal.com]

Complications : chylothorax, chylopericardium, chylomediastinum Treatment : mostly surgical repair See diaphragmatic rupture for details. References: [5] [11] [12] [13] [14] [amboss.com]

Treatment & Monitoring What are the treatments for the condition? The goal of treatment is to control the symptoms. Treatments vary depending on how the heart has been damaged. [medicineonline.com]

Treatments Because traumatic aortic transection is a life-threatening condition, treatment is needed immediately. The most common treatment is endovascular treatment to repair the damaged area. [cedars-sinai.edu]

We offer: Modern facilities : A Level 1 Adult and Pediatric Trauma Center equipped with advanced imaging technology Emergency care : Surgeons on-call 24/7 for evaluating and treating traumatic aortic injury Advanced Treatments : The latest treatment options [heart.ucla.edu]

Your long-term outlook greatly depends on how quickly you get treatment. Seek medical treatment immediately if you think you have this condition. [healthline.com]

 Asymptomatic – observation  Symptomatic – surgical exploration and repair  Cardiac rupture worst prognosis  Only 20% survive 16.  Central venous line  Cardiac catheterization  Coronary A. rupture  Aortic dissection  Pericardiocentesis  Pericardial [slideshare.net]

Prognosis [ edit ] The prognosis of myocardial rupture is dependent on a number of factors, including which portion of the myocardium is involved in the rupture. [en.wikipedia.org]

[…] asymptomatic or unspecific findings (e.g., chest pain, dyspnea ) In case of rupture: signs of hemorrhagic shock ( tachycardia, hypotension ) Diagnostics Initial test: chest x-ray Mediastinal widening Tracheal deviation Hemothorax Further tests Treatment Prognosis [amboss.com]

Despite substantial progress in the detection, quantification, characterization, management, and prognosis of pericardial diseases, and the recent guidelines and recommendations, there is only limited evidence-based data to guide the management of pericardial [acls.com]

Right ventricular infarction as an independent predictor of prognosis after acute inferior myocardial infarction. N Engl J Med. 1993 Apr 8;328(14):981-8. [teikyo-cvs.com]

References: [1] [2] [3] [4] Blunt chest trauma Chest wall injury Etiology : mostly blunt trauma, pathologic fractures, nonaccidental trauma ( child abuse ) Clinical features Diagnostics Complications Pneumothorax Hemothorax Especially in the elderly: [amboss.com]

The most common etiology of LV pseudoaneurysm is AMI. (LV pseudoaneurysm is twice as common with inferior AMI as it is with anterior AMI.) LV pseudoaneurysms may also develop after surgical interventions, especially after mitral valve replacement. [emedicine.medscape.com]

[…] tomography can show pericardial positioning of a pacemaker lead, which, as well as pacemaker dysfunction, suggests late cardiac rupture. 8 Finally, pericardial effusion associated with infection of the pacemaker implantation site suggests a bacterial etiology [elsevier.pt]

Etiology and Pathophysiology In the past century advances in science and technology generally influenced quality and duration of human life positively. [ispub.com]

Epidemiology Among the causes of death in all age groups, deaths due to trauma rank third after cardiovascular diseases and cancer ( 2 ). Recently, most common cause of death under age 40 is accidents. [ispub.com]

Pediatric blunt cardiac injury: Epidemiology, clinical features, and diagnosis. Pediatric Emergency Medicine Collaborative Research Committee: Working Group on Blunt Cardiac Injury. J Trauma 1996;40: 61-67. 36. Healey MA, et al. [ahcmedia.com]

Pathophysiology is unclear, but the timing of the blow in relation to the cardiac cycle may be important. Initial rhythm is usually ventricular fibrillation. [merckmanuals.com]

Regarding the pathophysiology of cardiac contusions, it appears the injury is caused by direct pressure on the myocardium and by indirect effects caused by increases in intrathoracic pressures with shear stress happening at the same time. [autoaccident.com]

Pathophysiology Blunt trauma can induce myocardial lesions by several mechanisms: (1) direct transfer of energy during the impact on the thorax; (2) rapid deceleration of the heart; and (3) compression of the heart between the sternum and the spine. [anesthesiology.pubs.asahq.org]

Etiology and Pathophysiology In the past century advances in science and technology generally influenced quality and duration of human life positively. [ispub.com]

Patients may demonstrate the pathophysiologic patterns of tamponade (see Chapter 19), left ventricular failure, right ventricular failure, acute VSD (see Chapter 15), acute valvular regurgitation (see Chapter 16), or MI. [tele.med.ru]

To be consistent with the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure [43], this level of BP will now be termed "prehypertensive" and is an indication for lifestyle modifications [books.google.com]

Lidocaine in the prevention of primary ventricular fibrillation: A double-blind, randomized study of 212 consecutive patients. N Engl J Med 1974;291: 1324-6. ‎ Página 366 - Modig J, Borg T, Karlstrom G, Maripuu E, Sahlstedt B. [books.google.es]

On occasion, open replacement surgery will be offered, thereby removing the damaged portion of the aorta and placing a graft where the tissue was removed in order to prevent blood from leaking from the aorta. [cedars-sinai.edu]