Lee Carlin, Jebbia Mallory, Morchi Raveendra, Grigorian Areg, Nahmias Jeffry
Division of Trauma, Burn, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA.
Department of Surgery, Desert Regional Medical Center, Palm Springs, CA, USA.
Am Surg. 2025 Mar;91(3):423-433. doi: 10.1177/00031348241307400. Epub 2024 Dec 11.
Cardiac injuries pose challenging diagnostic and management dilemmas. Cardiac trauma can be classified by mechanism into blunt and penetrating injuries. Penetrating trauma has an overall higher mortality and is more likely to require operative intervention. Due to the lethality of any cardiac injury, prompt diagnosis and treatment is critical for survival. The initial management of suspected cardiac injury should start with Advanced Trauma Life Support (ATLS) protocols followed shortly by directed diagnosis and management, which usually begins with a focused assessment with sonography in trauma (FAST) examination. In contrast to traditional ATLS protocols, some centers have adopted an assessment of "circulation before "airway" and "breathing"; however, this is an evolving concept. In this article, we provide an overview on the management of penetrating and blunt cardiac injuries, including use of physical exam, laboratory tests, imaging, and surgery.
心脏损伤带来了具有挑战性的诊断和管理难题。心脏创伤可根据机制分为钝性伤和穿透伤。穿透伤总体死亡率更高，更有可能需要手术干预。由于任何心脏损伤都具有致命性，及时诊断和治疗对生存至关重要。疑似心脏损伤的初始管理应从高级创伤生命支持（ATLS）方案开始，随后不久进行针对性诊断和管理，这通常从创伤重点超声评估（FAST）检查开始。与传统的ATLS方案不同，一些中心采用了“循环优先于气道和呼吸”的评估方法；然而，这是一个不断发展的概念。在本文中，我们概述了穿透性和钝性心脏损伤的管理，包括体格检查、实验室检查、影像学检查和手术的应用。
