The Eastern Association for the Surgery of Trauma recently released an update of their practice guideline for screening for blunt cardiac injury. Although the bulk of the guideline remains the same, a few areas have been updated to reflect advances since its original 1998 release.
Here is a quick summary of the new guidelines. Level 1 (best data):
- If blunt cardiac injury is suspected, an EKG should be obtained (no change)
Level 2 (okay data):
- If a new arrhythmia is seen on EKG, admit for monitoring. If not new, compare with an old EKG to determine need for admission. (updated)
- If the EKG is normal and troponin I is normal, BCI is ruled out. If the EKG is normal and troponin I is abnormal, admit for monitoring. (new)
- If the patient is unstable or the arrhythmia persists, obtain a cardiac echo. (updated)
- Sternal fracture is not predictive of BCI (moved from level 3)
- CPK should not be obtained (modified and moved from level 3)
- Nuclear medicine studies should not be obtained (no change)
Level 3 (data not so good):
- Elderly patients with known cardiac disease, unstable patients, and those with abnormal EKG can safely undergo surgery with appropriate monitoring (no change)
- Troponin I should be measured routinely in suspected BCI, and if elevated should prompt monitoring and serial testing (new)
- Cardiac CT or MRI may help differentiate acute MI from BCI to determine need for catheterization and/or anti-coagulation (new)
The EAST guidelines are just that, guidelines. They are not a complete management algorithm. I have combined this new information with an existing algorithm based on the old EAST guidelines. Feel free to download this algorithm using the link below. As always, I welcome any comments.
Click here to download the blunt cardiac injury algorithm
Reference: Screening for by cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma 73:(5) Supplement 4, S301-S306, 2012.