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An ED Approach to Blunt Aortic Injury and Myocardial Confusion Steven Issley, MD, CCFP Emergency Medicine McGill University September 12, 2001 Overview Blunt aortic injury (BAI) Myocardial contusion Focus: which investigations when should these investigations be done how sensitive are these investigations Case One Sunday, 1600h. Case One Sunday, 1600h. On the way home from an afternoon of bongos in the park. 20 yo healthy, but not-so-smart male Trying to beat the light @ 80 km/h... Case One Sunday, 1600h. On the way home from an afternoon of bongos in the park. 20 yo healthy, but not-so-smart male Trying to beat the light @ 80 km/h... T-boned to passenger’s side… Case One Sunday, 1600h. On the way home from an afternoon of bongos in the park. 20 yo healthy, but not-so-smart male Trying to beat the light @ 80 km/h... T-boned to passenger’s side… As usual, being drunk, he walks out of his car without a scratch. (...except for scratching his head in disbelief!) Case One Sunday, 1600h. On the way home from an afternoon of bongos in the park. 20 yo healthy, but not-so-smart male Trying to beat the light @ 80 km/h... T-boned to passenger’s side… As usual, being drunk, he walks out of his car without a scratch. (...except for scratching his head in disbelief!) He’s all yours! Case One Normal CXR Is this patient at risk for aortic dissection? What Next? A) discharge: no injuries and CXR is reassuring B) hCT chest; if normal discharge. C) angio, as high risk, despite negative studies BAI: stats Aorta great vessel injury 1-4% of blunt chest traumas 20% incidence when BAI suspected (mechanism or wide mediastinum) 75-90% ruprured thoracic aorta -- immediate death If untreated: 30% die within 1 day 60% die within 1 week 90% die within 1 month 71-84% survive with prompt intervention BAI: pathophysiology Deceleration: vertical (30 ft / 10 m) horizontal (30 mph / 50 km/h) Mediastinum and diaphragm compression Traction Dissection, thrombosis, pseudoaneurism, hemorrhage