A Middle-Aged Man with Blunt Trauma and Hemopericardium

A Middle-Aged man had a single vehicle motor vehicle collision with significant energy.He was hypotensive upon arrival.A bedside ultrasound was done immediately.  Here are 3 clips.There is pericardial fluid with echogenic material, diagnostic of hemopericardium with thrombus.An ECG was recorded:What do you think?Sinus tachycardia.  There are Q-waves in II, III, aVF, and V3-V6.  There is ST elevation in the same leads.  The T-waves are inverted in V4-V6, and are beginning to invert in II, III, aVF.   This is diagnostic ofsubacute MI.What do you conclude?This explains everything.  There was subacute MI with myocardial rupture and hemopericardium that resulted in the patient becoming hypotensive and losing control of the vehicle.The initial troponin returned at 74 ng/mL.  This is very high andcannot occur acutely.  In other words, this cannot be due to trauma.  The ECG cannot occur with trauma either (Q-waves, ST Elevation, T-wave inversion). This confirms your diagnosis of non-traumatic myocardial rupture.The patient was taken to the operating room where he could not be saved.  You might think that death is inevitable from myocardial rupture, but it is not!In 1994, from our institution (Hennepin), Plummer et al. published this case series: Emergency department two-dimensional echocardiography in the diagnosis of nontraumatic cardiac rupture.  23(6):1333-1342; June 1994.In it...
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