The use of echocardiography in the emergency management of nonpenetrating traumatic cardiac rupture

Three young adults, all drivers involved in three separate motor vehicle accidents that occurred in Portage County, Ohio, during a three-week period, sustained blunt, nonpenetrating chest trauma that resulted in right atrial rupture and cardiac tamponade. On arrival in the emergency department, all were hypotensive and complained of chest pain; only one had jugular venous distension and upper body cyanosis. All had normal chest radiographs, and one had ECG ST elevation. Echocardiography showed a moderate-sized pericardial effusion and signs of cardiac tamponade in all three. Two of the three survived emergency thoracotomy and repair of the right atrial rupture. These cases demonstrate the importance of echocardiography in diagnosing cardiac tamponade as the classic signs are not always present.