ACUTE CORONARY SYNDROME AS A CAUSE OR A CONSEQUENCE OF A SEVERE THORACIC BLUNT TRAUMA – A CASE REPORT
Abstract
Background: Acute coronary syndrome associated with severe thoracic trauma may be a concomitance, a coincidence or a subsequent event, requiring specific adaptation of emergency management. The purpose of the study- to highlight the special circumstances of an ACS occurrence in a severe thoracic blunt trauma
Material and method: Clinical case presentation - A 29 years old patient with severe thoracic blunt trauma, secondary brought to a level I trauma center ED. First assessment - serious chest trauma, malignant cardiac dysrhythmias, severe head trauma, spinal cord and pelvic fracture, progressive shock. Increased levels of cardiac biomarkers with atypical progression. Several hypotheses for the acute cardiac damage etiology considered, as toxic, ACS both causing or following the accident, but, taking into account the kinematics and severity of thoracic trauma, it was also considered the possibility of cardiac contusion occurred. Considering circumstances, the management has been orientated to life-threatening lesions and damage control and advance imagistic to confirm cardiac injury causes.
Conclusions: The strong suspicion for ACS associated with significant thoracic blunt trauma poses questions about his etiology (coronary artery disease, aortic or coronary artery traumatic disrupture), and, subsequently, about possible primary reperfusion procedures required. The concomitance of brain injury, hemorrhage and pulmonary contusion limited treatment of a potential ACS from CAD, fast volume replacement and ventilation strategies, in the context of shock and risk of secondary brain and spinal cord injury. HEMS has to be involved with a primary mission to evacuate directly to a level I trauma center this type of patients.
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