Blunt Cardiac Injury Algorithm

Based on Biffl, Fawley & Mohan, J Trauma Acute Care Surg 2024 ('What You Need to Know')

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A: Suspected Blunt Cardiac Injury (BCI)

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BCI ranges from occult, inconsequential contusion to rapidly fatal cardiac rupture. Mechanisms: direct blow to the chest, impact of the heart against the sternum, compression between sternum and spine, deceleration (high-speed MVC, fall from height), blast, or lateral chest trauma. The right ventricle is most often affected because of its anterior position.

Clinical Note

The goal is not to diagnose BCI itself but to identify and treat significant BCI (SigBCI): dysrhythmias or pump failure requiring intervention. In Biffl et al., only 5% of patients admitted with suspected BCI had SigBCI. Sternal fractures alone are NOT associated with BCI.