Evaluation of the hemodynamically stable adult with suspected blunt cardiac injury and FAST without hemopericardium

BCI: blunt cardiac injury; ECG: electrocardiogram; FAST: Focused Assessment With Sonography for Trauma; ED: emergency department; STEMI: ST-elevation myocardial infarction; TTE: transthoracic echocardiogram; TEE: transesophageal echocardiogram; CT: computed tomography.

* Refer to UpToDate content and algorithm on management of adults with blunt chest trauma in the emergency department.

¶ TTE is the initial study performed for many patients with suspected BCI, but TEE is more sensitive for identifying the cause of persistent hemodynamic instability or other problems thought to be related to BCI. However, TEE is contraindicated in a patient with suspected or diagnosed esophageal injury.

Δ Evidence of significant chest wall trauma includes sternal fracture, manubrium fracture, retrosternal hematoma.

◊ STEMI due to BCI is very rare.

§ If no prior ECG is available for comparison, a conduction block that is uncommon for the patient's age or comorbidities should be considered new.

¥ The time interval to repeat troponin may vary if site is using a high-sensitivity assay.

‡ Signs or symptoms of BCI include heart failure, abnormal heart sounds (eg, muffled sounds, holosystolic or diastolic murmur), unexplained tachycardia, bradycardia, or hypotension, new dysrhythmia, or conduction block (eg, bundle branch block).