Severe cardiac trauma or myocardial ischemia? Pitfalls of polytrauma treatment in patients with ST-elevation after blunt chest trauma

• ECG changes after blunt chest trauma can be misleading.
• Only by knowing the cause of accident can avoid erroneous time-intensive diagnostics and ensure a proper overall assessment.
• A TEE can be a useful early adjunct in trauma management in the setting of ongoing instability because it can guide resuscitation efforts.
• A stantardized preclinical – trauma room protocol according to ALTS® should be used during transfer.
• A thromblysis should be avoided in the acute setting because a blunt chest trauma can mimic a myocardial infarction.

IntroductionThoracic injuries are the third most common injuries in polytrauma patients. The mechanism of injury and the clinical presentation are crucially important for adequate emergency treatment.Presentation of caseHere we present a case of a 37-year-old male who was admitted to our level-1 trauma center after motor vehicle accident. The emergency physician on scene presented the patient with a myocardial infarction. During initial clinical trauma assessment the patient developed circulatory insufficiency so that cardiopulmonary resuscitation was necessary. Considering the preclinical and clinical course it was decided to proceed with thrombolysis. Despite consistently sufficient resuscitation measures circulatory function was not restored and the patient remained in asystole and passed away.DiscussionThe initial assessment showed cardiopulmonary instability. After applying thrombolysis a therapeutic point of no return was reached because surgical intervention was impossible but autopsy findings showed severe myocardial and pulmonary contusions likely due to shear forces.ConclusionThis case outlines the importance of understanding the key mechanism of injury and the importance of communication at each stage of healthcare transfer. A transesophageal echocardiography can help to identify injuries after myocardial contusion.