THE CRUSHED CHEST CARDIOVASCULAR TRAUMA

Direct and indirect force, concussion, deceleration and blast are the main causes of cardiovascular trauma. The history, signs of pericardial friction or tamponade, an altered cardiac silhouette, electro‐cardiographic abnormalities and hæmodynamic changes are the main diagnostic features. The injuries are usually well tolerated, are often overlooked, and seldom cause death unless a fatal arrhythmia or cardiac rupture occurs. Pericardiocentesis can be lifesaving in tamponade. Surgical exploration may well be indicated for tamponade, constrictive pericarditis, rupture of a cardiac chamber or injury to a valve, or disruption of the pericardium. Widening of the mediastinum and alteration in peripheral pulses are the commonest findings in cases of injury to the great vessels. Early surgery for such injuries is indicated, though occasionally conservative management is successful.