Management of Pediatric Cardiac Trauma in the ED

Cardiac trauma, though rare in children, is associated with a variety of clinical syndromes and found most often in cases of multisystem injury. Blunt chest trauma may manifest as cardiac contusion, though complications including cardiac tamponade, aortic injury, or structural cardiac damage may result. Commotio cordis may result if the impact occurs at a specific time in the cardiac cycle. Diagnosis of cardiac injury may be complicated and necessitate a high index of suspicion, involving the consideration of cardiac enzymes, electrocardiogram, echocardiography, computed tomography, or angiography. Children, particularly, may present without classic signs and symptoms making the diagnosis more challenging. Penetrating cardiac traumas are far rarer, but often require rapid, aggressive resuscitation.