Cardiac contusion. The effect on operative management of the patient with trauma injuries
P. Ross Jr, L. Degutis and C. C. Baker
Department of Surgery, Yale University School of Medicine, New Haven, Conn. 06510.
Sixty-four patients with cardiac contusion documented by
electrocardiographic changes and creatine kinase MB fraction assay
following blunt chest injury were reviewed to assess the impact of cardiac
contusion on subsequent management. Fifty-eight patients had elevated
creatine kinase MB levels; 35 patients had electrocardiographic
abnormalities, including ST-segment and T-wave changes (25), premature
ventricular contraction (ten), right bundle-branch block (nine),
atrioventricular block (three), atrial fibrillation (three), and premature
atrial contraction (two). Thirty patients underwent general anesthesia.
There were only four perioperative complications: ventricular ectopy,
ventricular fibrillation, nodal rhythm, and pulmonary edema. There were no
deaths attributable to cardiac contusion. In summary, patients with blunt
trauma who have sustained a cardiac contusion can undergo elective
operation with a low incidence of complication. In the emergency setting,
however, hemodynamic monitoring for early detection of arrhythmias is
indicated.
