* TSA HDAC echocardiogram is helpful to further evaluate MCC. Biffl, et al. [3] Retrospective 4-year review of all patients with high-risk blunt chest trauma 359 107 MCC 14 dysrhythmias 3 cardiogenic shock with 2 deaths * Cardiac enzymes (CPK, CKMB) have no useful role in the evaluation of patients with myocardial contusion. * Risk factors associated with complications from MCC include age > 55,

abnormal admission EKG (except sinus tachycardia), absence of chest pain, head injury with GCS < 8, and pelvic fracture. Cachecho, et al [20] Retrospective 6-year review of patients with blunt thoracic trauma 336 19 *Young patients with minor blunt thoracic trauma and minimally abnormal EKG do not benefit from cardiac monitoring. * Evaluation of MCC should not be pursued in hemodynamically stable patients. Karalis, et al [21] 12-month

prospective evaluation of patients admitted with blunt thoracic trauma 105 8 * Only patients who selleck kinase inhibitor have complications from MCC benefit from echocardiogram. Transesophageal echo may be beneficial if thoracic trauma limits the quality of a trans-thoracic study. Adams, et al. [22] 12-month prospective evaluation of patients with blunt thoracic trauma 44 2 acute myocardial infarctions Cardiac troponin I accurately detects cardiac injury after blunt chest trauma. Echocardiography should be reserved for patients who are hypotensive either on admission or during the initial observation period. It can be helpful in diagnosing selleck chemical apical thrombi, pericardial effusion and tamponade. Echocardiograms added little clinical information for patients who were normotensive. Radionuclide imaging studies are too sensitive and lack specificity in the setting of trauma, so are not helpful in the evaluation of blunt cardiac trauma. The EAST guidelines recommend against following cardiac enzymes because they are not helpful in predicting complications from BCI [1]. A review by Biffl, et al evaluated

the management of suspected cardiac injury heptaminol at a Level-One trauma center in Denver. Screening creatinine phosphokinase or troponin levels were frequently elevated post-injury and did not correlate with clinically significant BCI [3]. They identified clinical risk factors for complications in BCI including age greater than 55, an abnormal EKG at admission, the absence of chest pain, a widened mediastinum on imaging, a head injury with a Glasgow coma score less than 8, and pelvic fractures. In both univariate and multivariate analysis, these factors were more predictive of complications from BCI than cardiac enzymes [3]. Guidelines are helpful in directing the evaluation when thoracic injuries are suspected. The recommendations from EAST support a limited evaluation for negative screening tests and asymptomatic patients. If the initial screening evaluation is positive the algorithm is redirected to evaluate more specific injury patterns.