Cardiac and mediastinal trauma.

Injuries to the heart and mediastinal vessels comprise one of the leading causes of traumatic death. Although the presumed overall mortality rate of critical cardiac injury is very high, the survival rate of patients with cardiac trauma who arrive in the ED with vital signs has been reported to be significant, especially with penetrating as opposed to blunt chest trauma. Patients with lethal injury to the heart and great vessels may present with deceptively few signs or symptoms. The survival of these patients is entirely dependent on the ability of the emergency physician to make the correct diagnosis and expedite definitive surgical treatment. Thus, it is prudent for emergency physicians to maintain a high index of suspicion for these injuries in caring for patients with trauma to the chest. Other injuries, such as esophageal, diaphragmatic, tracheal, and bronchial wounds must also be considered.