295.2 🩺 國考版

295.2.1 高頻考點

295.2.1.1 Blunt Trauma Types

• Contusion (most common in survivors; RV common)
• Rupture (high mortality; RA most common)
• Valvular (TV most common in blunt)
• Coronary dissection / occlusion
• Aortic transection (deceleration)
• Conduction injury

295.2.1.2 Cardiac Contusion

• Diagnosis: troponin (best NPV at 4-6 hr), ECG, echo
• Most common arrhythmia: PVCs
• Telemetry monitor 24-48 hr if abnormal
• Most recover

295.2.1.3 Aortic Transection

• Deceleration injury
• Aortic isthmus (fixed point)
• CXR signs: widened mediastinum, apical cap, depressed L main bronchus
• CT angio: gold standard
• TEVAR > open in modern era
• Esmolol + BP < 120 pre-repair

295.2.1.4 Penetrating

• Stab > gunshot survival rate
• Tamponade common
• ED thoracotomy for peri-arrest stab wounds (better outcome than gunshot)

295.2.1.5 Iatrogenic

• Cath: RA perforation
• Pacemaker lead: perforation, tamponade
• TAVR: paravalvular, coronary, conduction
• Watch with new device implantation

295.2.1.6 ED Thoracotomy

• Indications: penetrating chest + signs of life + peri-arrest
• Stab > gunshot outcomes
• Goals: tamponade relief, cardiac massage, hemostasis

295.2.2 易混淆比較

Type	Cause	Common Injury	Diagnosis	Treatment
Contusion	Blunt	Myocardium (RV)	Trop + ECG + echo	Telemetry, supportive
Rupture	Blunt	RA (most)	FAST	Emergent surgery
Aortic	Deceleration	Isthmus	CXR + CT angio	TEVAR + esmolol
Penetrating	Stab/gunshot	Tamponade	FAST	ED thoracotomy / OR
Iatrogenic	Cath, lead	RA perforation	Echo	Pericardiocentesis + reverse AC
Commotio cordis	Blunt impact	VF	AED capture	AED + CPR

295.2.3 Special Topics

295.2.3.1 Cardiac Trauma Scoring

• Modified Cardiac Trauma Score: anatomy + physiology
• NTDB (National Trauma Data Bank): outcomes data
• Trauma-associated cardiac arrest: very poor prognosis

295.2.3.2 FAST (Focused Assessment with Sonography for Trauma)

• Pericardial view
• Quick + non-invasive
• 95%+ sensitive for pericardial fluid in trauma
• Standard of ED trauma assessment

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