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Question
A 25-year-old male was brought in by EMS with a stab wound to the chest. What's the diagnosis?
Answer
- Initial Assessment of ABC, ATLS primary survey guidelines.
- Evaluate for tension pneumothorax or cardiac tamponade in all patients presenting with chest trauma and shock.
- Cardiac Box: Surrounded by sternal notch, xiphoid process and nipples.
- Order of injury: Right Ventricle --> Left Ventricle --> Right Atrium --> Left Atrium
- Beck’s Triad: Hypotension, JVD, muffled heart sounds may not be present initially.
- Conduct FAST exam to examine for cardiac tamponade, hemothorax, pneumothorax.
- Cardiac Tamponade more common from stab wounds than from gun shot wounds.
- Hemodynamically unstable patients require immediate operative therapy after quick bedside assessment (physical exam, ultrasound, chest tube as needed)
Differential Diagnosis: Bronchial injury, Diaphragm injury, Hemothorax, Tension Pneumothorax, Aortic Transection, Esophageal injury, Pneumomediastinum
Evaluation: Ultrasound (FAST Exam), CXR, CTA in stable patients, ECG, troponin.
Management: Penetrating cardiac trauma require emergent thoracotomy, pericardial window.
References
Clancy K, Velopulos C, Bilaniuk JW, et al. Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S301-6.
El-menyar A, Al thani H, Zarour A, Latifi R. Understanding traumatic blunt cardiac injury. Ann Card Anaesth. 2012;15(4):287-95.
Tintinalli's 7th Edition. Emergency Medicine Manual. Chapter 164: Cardiothoracic Trauma.