Department of Emergency and Hospital Medicine, United States of America.
Department of Emergency and Hospital Medicine, United States of America.
Am J Emerg Med. 2020 Jun;38(6):1299.e3-1299.e5. doi: 10.1016/j.ajem.2020.02.055. Epub 2020 Feb 26.
Patients who experience trauma, particularly thoracic trauma, may be at risk for missed cardiac injury.
We present a case of a 36-year-old male presenting to the Emergency Department (ED) as a trauma after a high-speed motor vehicle crash. After computed tomography (CT) scans revealed a right hemopneumothorax and multiple orthopedic injuries, the patient was admitted to the trauma neuroscience intensive care unit (TNICU), where telemetry revealed ST elevations. An electrocardiogram (EKG) was performed and he was noted to have an acute anterolateral STEMI. The patient was intubated and underwent a cardiac catheterization that revealed a dissection of his left anterior descending (LAD) coronary artery and a stent was successfully placed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In cases of trauma patients who can't report the symptoms they are experiencing, or have distracting injury, there is the potential for a missed diagnosis of either significant cardiac injury and/or myocardial infarction (MI). Emergency physicians should be aware that an EKG is recommended in the ED evaluation of a trauma patient, especially those with thoracic trauma.
经历创伤尤其是胸部创伤的患者可能存在心脏损伤漏诊的风险。
我们报告了 1 例 36 岁男性患者，因高速机动车事故后到急诊科就诊，诊断为创伤。胸部 CT 扫描显示右侧血气胸和多处骨科损伤后，患者被收入创伤神经重症监护病房（TNICU），监护仪显示 ST 段抬高。行心电图（EKG）检查，提示急性前侧壁 ST 段抬高型心肌梗死。患者行气管插管并进行了心脏导管检查，结果显示左前降支（LAD）冠状动脉夹层，成功放置了支架。
为什么急诊医生应该了解这个病例？：在无法报告自身症状或存在干扰性损伤的创伤患者中，可能会漏诊严重的心脏损伤和/或心肌梗死（MI）。急诊医生应该意识到，在急诊科评估创伤患者时，尤其是胸部创伤患者，推荐进行心电图检查。
