Cardiac Trauma in Children

Although major penetrating or blunt cardiac trauma is rare in children, severe sequelae may result if patients are not managed in a thorough and systematic manner. Penetrating cardiac injuries are fatal in most patients, but survival is possible in patients who maintain vital signs until hospital arrival and can be transported to the OR without delay.The most common cardiac injury from blunt trauma is a cardiac contusion. Patients who have normal vital signs, examination findings, and ECG on arrival are very unlikely to have significant cardiac sequelae. Differences exist in the literature regarding the proper evaluation of blunt cardiac injury, but all patients should have an initial ECG and careful physical examination. Any significant abnormality requires admission for monitoring, frequent reexamination, and consideration of further testing such as troponins, serial ECGs, and/or an echocardiogram.