trauama/cardiac injury

See Explanation

[]

Question 1 / 1

683b964d31242d93219d2c30

Emergency

trauama

cardiac injury

Case History

A 35-year-old woman is admitted to the emergency department after a high-speed head-on collision. Upon arrival, she is obtunded, and her vital signs are: blood pressure 70/40 mmHg, pulse 125/min and thready, respirations 22/min. Her jugular venous pressure is flat, and central venous pressure is estimated to be 1 cm H2O. Physical examination reveals equal bilateral breath sounds and muffled heart sounds with distant murmurs. The abdomen is soft, non-distended, and non-tender with sluggish bowel sounds. A focused assessment with sonography for trauma (FAST) exam is negative for pericardial fluid, but shows free fluid in the abdomen. A stat chest X-ray reveals a significantly widened mediastinum (>10 cm). Given these findings, what is the most likely diagnosis and the critical immediate next step in management?

Lab Parameter	Value	Reference Range
Hemoglobin	7.8 g/dL	12-16 g/dL
Hematocrit	23%	36-48%
White Blood Cell Count	14.5 x 10^9/L	4.5-11.0 x 10^9/L
Lactate	4.2 mmol/L	0.5-2.2 mmol/L
Arterial Blood Gas pH	7.28	7.35-7.45
Arterial Blood Gas pCO2	35 mmHg	35-45 mmHg
Arterial Blood Gas pO2	80 mmHg	75-100 mmHg
Arterial Blood Gas Bicarb	18 mEq/L	22-26 mEq/L

A ) Cardiac contusion leading to cardiogenic shock, requiring immediate inotropic support and serial troponins.

B ) Cardiac tamponade with pulsus paradoxus, necessitating emergent pericardiocentesis.

C ) Tension pneumothorax with tracheal deviation, requiring urgent needle decompression followed by chest tube insertion.

D ) Ruptured thoracic aorta with massive hemorrhage, requiring immediate resuscitative thoracotomy or endovascular repair.

E ) Flail chest with paradoxical chest wall movement, requiring mechanical ventilation and pain control.

Edit question