Management of adults with blunt chest trauma in the emergency department

ED: emergency department; E-FAST: extended focused assessment with sonography in trauma; ECG: electrocardiogram; AP: anteroposterior; CXR: chest radiograph; PTX: pneumothorax; CT: computed tomography; IV: intravenous; TEE: transesophageal echocardiography; PA: posterior-anterior; BAI: blunt aortic injury; US: ultrasound.

* For example, high-risk mechanisms of injury include (but are not limited to) MVCs with no seatbelt use, extensive vehicular damage, steering wheel deformity, or speed >40 miles per hour (>65 kilometers per hour); fall >20 feet (>6 meters); anything that causes rapid deceleration.

¶ FAST with pericardial fluid is concerning for hemopericardium and cardiac rupture. If patient is stable, immediately consult cardiac surgery and cardiology for echocardiogram.

Δ We obtain an ECG in a patient with evidence of significant anterior chest wall trauma (eg, sternal fracture, manubrium fracture, retrosternal hematoma); circumstances of trauma suggestive of heart disease; active signs or symptoms consistent with heart disease, including chest pain suggestive of acute coronary syndrome, heart failure, abnormal heart sounds, unexplained tachycardia, bradycardia, or hypotension, new dysrhythmia; or major mechanism of injury in an older adult or a patient with known coronary artery disease.

◊ Secondary survey is a history and head-to-toe physical exam.

§ For CXR findings concerning for BAI, refer to UpToDate content on blunt thoracic trauma or diagnostic algorithm for blunt aortic injury in adults.