![]() ![]() Initial cardiac troponins can be elevated. The ECG can be unremarkable, demonstrate sinus tachycardia, or even demonstrate more severe dysrhythmias such as supraventricular tachycardia, atrial fibrillation, and a right bundle branch block. There will typically be visible signs of chest trauma such as bruising and the patient will often complain of chest pain and dyspnea. This patient is presenting after blunt chest trauma (which is common in motor vehicle accidents) with chest pain, elevated troponins, and an elevated pulmonary capillary wedge pressure suggesting a diagnosis of a cardiac contusion. A cardiac contusion is a blunt injury to the heart which can disrupt the mechanical and electrical function of the heart. Which of the following is the most likely diagnosis? Physical exam is notable for an uncomfortable young man with bruising over his chest wall. The patient is currently complaining of chest pain. Initial workup demonstrates that the patient’s pulmonary capillary wedge pressure and troponins are elevated. The patient is given 2 liters of Ringer lactate solution and morphine. His temperature is 99.5☏ (37.5☌), blood pressure is 107/58 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. The patient’s echocardiogram (ECG) is notable only for sinus tachycardia. The patient was a front seat unrestrained driver in a head-on collision. A 27-year-old man presents to the emergency department after a motor vehicle collision. Review NCCPA Blueprint Topic: Ingestion of toxic substances or foreign bodiesĢ. It may be used to pass bags of drugs if ingested by a packer/stuffer but would not aid in the management of caustic ingestion. Answer 5: Polyethylene glycol or whole bowel irrigation has limited indications.Answer 4: Observation is certainly a part of this patient’s care however, she must also receive endoscopy to assess for any esophageal/GI tract injury.This well-appearing patient has no airway concerns. ![]() Answer 3: Intubation would be indicated if the patient was failing to protect their airway or if they had impending airway loss.Answer 1: Dilute hydrochloric acid or administration of any agent to titrate the ingestion is always contraindicated as this will lead to more tissue damage.Subsequent management involves endoscopy (typically within 12 to 24 hours of ingestion) to assess the extent of the damage and plan any further treatment that may be needed. Patients should immediately be resuscitated following the ABC’s (airway, breathing, and circulation). Subsequently, esophageal strictures form due to scarring of the affected tissue. Any patient presenting after caustic ingestion should have an endoscopy performed between 12 and 24 hours of presentation. Injury due to ingestion of alkaline fluids such as drain/oven cleaner occurs rapidly in the first minutes to hours and is characterized by liquefactive necrosis of the esophageal tissue. Ingestion of caustic fluids (acid or alkali) such as drain cleaner may lead to esophageal damage and stricture. ![]()
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