Stable Penetrating Chest Trauma
Annotation for Point N
Cardiac injury may be suspected by location of the entry wound (between the midclavicular lines anteriorly), clinical examination (jugular venous distension, muffled heart sounds, and/or pulsus paradoxus), or plain CXR (widened shadow or path of the missile). Unfortunately Beck’s triad of clinical findings (hypotension, muffled heart sounds, and distended neck veins) is present in atmost 10%of patients subsequently documented to have sustained a cardiac injury.48 Thus, a degree of clinical suspicion is often required. As noted previously, FAST is an effective screening tool, although it cannot reliably rule out pericardial fluid in the setting of a hemothorax. In an entirely stable patient, it may be reasonable to consider a CT scan to evaluate the mediastinum.