Hegde Rakesh, Lafayette Nathan, Sywak Michael, Ricketts Gregory, Otero Jorge, Kurtzman Scott, Zhang Zhongqiu
Waterbury Hospital, CT, United States.
Trauma Case Rep. 2017 Dec 6;13:26-29. doi: 10.1016/j.tcr.2017.11.004. eCollection 2018 Feb.
Right sided tears or rupture are the most common injury to the heart after blunt chest trauma. The majority of these injuries are to the thin walled atrium. Reports of localized right atrial appendage rupture are rare. The classical features of Beck's triad are unreliable in the trauma bay. With the advent of EFAST (Focused assessment with sonography for trauma extended to thorax), Beck's triad should be considered but not used as the primary clinical tool for diagnosis of cardiac tamponade [1]. EFAST aids in rapid diagnosis and definitive care [3].
Our patient was a 17 year old male who presented with hypotension after a rollover motor vehicle accident. He presented with a grossly negative physical exam and positive EFAST for pericardial effusion with tamponade physiology. We performed an emergency pericardiocentesis and expedited transportation for operative exploration. A Right atrial appendage injury was identified and repaired and patient recovered uneventfully.
EFAST examination aids in rapid diagnosis of cardiac tamponade in the trauma setting. Pericardiocentesis facilitates temporizing the hemodynamics in preparation for operative exploration.
右侧心脏撕裂或破裂是钝性胸部创伤后最常见的心脏损伤。这些损伤大多发生在薄壁心房。局限性右心耳破裂的报道很少。贝克三联征的典型特征在创伤病房并不可靠。随着EFAST（扩展至胸部的创伤超声重点评估）的出现，应考虑贝克三联征，但不能将其用作诊断心脏压塞的主要临床工具[1]。EFAST有助于快速诊断和确定性治疗[3]。
我们的患者是一名17岁男性，在翻车机动车事故后出现低血压。他的体格检查结果大致为阴性，但EFAST显示有心包积液伴心脏压塞生理学表现。我们进行了紧急心包穿刺术，并加快转运以进行手术探查。发现右心耳损伤并进行了修复，患者恢复顺利。
EFAST检查有助于在创伤情况下快速诊断心脏压塞。心包穿刺术有助于暂时稳定血流动力学，为手术探查做准备。
