Abstract
The initial management of a patient with cardiac or great vessel trauma is to ensure airway and ventilation with adequate oxygenation, and treat shock according to ATLS protocol. FAST is a very useful adjunct tool in cardiac trauma because it allows diagnosis of injuries in the emergency room. Penetrating wounds to the anatomic area, known as the “cardiac box” (bordered superiorly by the clavicles, inferiorly by the xiphoid, and by the nipples laterally), should increase the suspicion of cardiac injury. Firearm injuries to the heart are more often associated with bleeding and exsanguination rather than tamponade. Definitive treatment involves surgical exposure through an anterior thoracotomy or median sternotomy with subsequent tamponade relief and/or hemorrhage control. The primary management of blunt cardiac injury (BCI) is supportive care. The role of surgery in BCI should be restricted to patients with structural abnormalities and/or a positive FAST. The clinical picture of great vessel trauma includes hypotension, unequal arterial pressures or pulses in the extremities, external evidence of major thoracic trauma, and palpable fracture of the sternum or thoracic spine. Indications for emergency thoracotomy include hemodynamic instability, significant bleeding in the thoracic drains, or radiographic evidence of a rapidly expanding mediastinal hematoma.