Unstable cardiac injury complicated with septic shock—a challenge

Background:Road traffic accident accounts for 70%to 80%of the blunt cardiac injury.The true incidence varies in the literature due to non-uniform criteria for diagnosis.Case Presentation:Here,we describe the case of a young male presenting after blunt chest injury and hemodynamic instability.Initially,the patient had frequent episodes of arrhythmias and hypotension due to cardiac injury per se.However,he was stabilized by day 2.Subsequently,patient developed cellulitis followed by septic shock and succumbed to cellulitis on day 5 of injury.Conclusion:Sepsis is difficult to be diagnosed and treated in the presence of cardiac injury.Myocardial depression has been found in sepsis,which contributes as an added comorbidity in an already compromised heart function.Sepsis also interferes with the diagnosis and follow-up of progress of blunt cardiac injury.

Changes and significance of serum troponin in trauma patients: A retrospective study in a level I trauma center

BACKGROUND: Elevated troponin I(TnI) is common among trauma patients. TnI is an indicator of myocardial injury, but clinical diagnosis of blunt cardiac injury cannot be based solely on an increase in TnI. Therefore, this study aims to explore the changes and clinical significance of serum TnI in trauma patients. METHODS: The clinical data of consecutive trauma patients admitted to our trauma center between July 1, 2017 and July 31, 2020 were retrospectively analyzed. According to TnI levels within 24 hours of admission, patients were divided into the elevated and normal TnI groups. According to the TnI levels after 7 days of admission, a graph depicting a change in trend was drawn and then analyzed whether TnI was related to in-hospital mortality. RESULTS: A total of 166 patients(69 and 97 cases with elevated and normal TnI, respectively) were included in this study. The average hospital stay, intensive care time, mechanical ventilation time, and in-hospital mortality were higher in the elevated TnI group than in the normal TnI group(P<0.05). The TnI level of trauma patients gradually increased after admission and peaked at 48 hours(7.804±1.537 ng/mL). Subsequently, it decreased, and then recovered to normal within 7 days. However, 13 patients did not recover. Logistic regression analysis revealed that abnormal TnI at 7 days was independently related to in-hospital mortality. CONCLUSIONS: Trauma patients with elevated TnI levels may have a worse prognosis. Monitoring the changes in serum TnI is important, which can reflect the prognosis better than the TnI measured immediately after admission.