Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

280 Cardiac Arrest Cardiac Trauma

■Post-resuscitation syndrome:

➣Cardiovascular dysfunction (12–24 h post arrest)

➣Reperfusion failure

➣Reperfusion injury with release of toxic metabolites

➣Coagulopathy

➣Infection

➣Systemic Inflammatory Response Syndrome (SIRS)

■Routine measures:

➣intensive cardiac care monitoring

➣change IV lines placed without sterile technique during code

➣administer IV fluids (NS)

➣correct hypoglycemia, acidosis, and electrolyte abnormalities

➣stress ulcer and DVT prophylaxis

➣continue anti-arrhythmic therapy (VF/VT arrest) and monitor

drug toxicity (eg QT interval, procainamide/NAPA level, etc.)

➣treat fever aggressively (decrease cerebral oxygen demand)

➣address underlying condition based on differential diagnosis

➣periodic assessment of neurologic status

complications and prognosis

n/a

Cardiac Trauma.....................................

JUDITH A. WISNESKI, MD

history & physical

■Recent blunt or sharp, penetrating trauma to chest or back

■Trauma resulting in an increase in intravascular pressure

■Sudden rapid decelerative force

Cardiac Trauma Can Result in Injury to Following Structures:

Pericardium

■Acute pericarditis (see Pericardial diseases)

■Pericardial effusion or tamponade (see Pericardial diseases)

Myocardium

■Contusion

➣Symptoms & Signs

Chest pain, arrhythmias (ventricular tachycardia, ventricular

fibrillation, atrial fibrillation)