Unpredictable cardiac arrest caused by blunt cardiac injuries with sternum fracture: a case report

Blunt cardiac injury (BCI) is common in road traffic accidents due to high energy injuries to the thorax and its structures, such as the anterior and posterior of the chest wall. The severity of BCI is high enough to cause many on-site deaths. However, patients with BCI may also be asymptomatic and exhibit normal findings; thus, diagnosis can be significantly challenging for many clinicians. Moreover, since BCI can be diagnosed through multiple serial tests, it is very important to always consider the possibility of BCI in high-risk patients . Diagnosis of BCI begins with suspicion of BCI, followed by repeated electrocardiograms, echocardiography, and cardiac biomarkers measurements along with intensive observation.

EFFECT OF STEERING WHEEL HEIGHT AND INCLINATION ANGLE ON BLUNT CARDIAC INJURY DURING THE THORAX-TO-STEERING WHEEL IMPACT

Blunt cardiac injury (BCI) in the traffic accidents usually causes serious consequences like heart failure or even death, and the impact of steering wheel to the thorax is one of the main causes of blunt heart injury. Therefore, more realistic heart models are needed to predict the biomechanical response and related injury of the heart during a thorax-to-steering wheel impact. This study developed three-dimensional finite element (FE) models of lungs, aorta and heart, and validated the models through published cadaver tests by comparing the contact force and intracardiac pressures in four heart chambers. Then, various simulations of thorax-to-steering wheel impact were carried out at different impact heights (lower, middle and higher) and different inclination angles of steering wheel (15°, 30°, 45° and 60°) to investigate the effects of impact height and inclination angle on heart injury. The result showed that (1) the biomechanical response of the heart model was agree with the test data; (2) the contact force, myocardial stress and intracardiac pressure were decreased when the inclination angle was increased; (3) when the impact height was middle and the inclination angle of steering wheel was 15°, the myocardial stress and intracardiac pressure were both maximum which indicated that the blunt heart injury was more likely to occur in this condition.

Complex open sternal fracture with impingement of the pericardium

The incidence of sternal fracture ranges from 3 to 8%. In more than half, they are associated with other organ trauma such as blunt cardiac injuries, rib, scapular or vertebral fractures. Hence, the presence of sternal fracture is considered a marker for significant transmission of energy. The management of isolated sternal fractures is usually non-operative with surgery reserved for displaced fractures or in cases of respiratory insufficiency. However, management may become challenging when they are associated with other significant trauma. We discuss a case of sternal fracture complicated by the presence of blunt cardiac injury, open pneumothorax, rib fractures, anterior flail chest and empyema.

Blunt Cardiac Injury: A Single-Center 15-Year Experience

In recent years, the incidence of blunt cardiac injury (BCI) has increased rapidly and is an important cause of death in trauma patients. This study aimed to explore early diagnosis and therapy to increase survival. All patients with BCI during the past 15 years were analyzed retrospectively regarding the mechanism of injury, diagnostic and therapeutic methods, and outcome. The patients were divided into two groups according to the needs of their condition—nonoperative (Group A) and operative (Group B). Comparisons of the groups were performed. A total of 348 patients with BCI accounted for 18.3 per cent of 1903 patients with blunt thoracic injury. The main cause of injury was traffic accidents, with an incidence of 48.3 per cent. In Group A (n = 305), most patients sustained myocardial contusion, and the mortality was 6.9 per cent. In Group B (n = 43), including those with cardiac rupture and pericardial hernia, the mortality was 32.6 per cent. Comparisons of the groups regarding the shock rate and mortality were significant ( P < 0.01). Deaths directly resulting from BCI in Group B were greater than those in Group A ( P < 0.05). In all 348 patients, the mortality rate was 10.1 per cent. When facing a patient with blunt thoracic injury, a high index of suspicion for BCI must be maintained. To manage myocardial contusion, it is necessary to protect the heart, alleviate edema of the myocardium, and control arrhythmia with drugs. To deal with those requiring operation, early recognition and expeditious thoracotomy are essential.