Question

A patient presents with chest pain and shortness of breath following a motor vehicle collision. An electrocardiogram shows sinus tachycardia and ischemic changes with an elevated troponin. The nurse should be highly suspicious for which injury?

A. Cardiac tamponade
B. Blunt cardiac injury
C. Aortic disruption
D. Pulmonary contusion

Answer 1

The patient's symptoms and ECG findings suggest a blunt cardiac injury, which is often caused by a significant impact to the chest and can lead to myocardial contusion. Elevated troponin levels in the context of trauma also indicate cardiac injury. Immediate medical evaluation and treatment are essential.

Step-by-step explanation:

The nurse should be highly suspicious for a blunt cardiac injury (B). The patient's symptoms of chest pain, shortness of breath, sinus tachycardia, ischemic changes on the electrocardiogram (ECG), and elevated troponin levels all point towards this type of injury. In blunt cardiac injury, the impact to the chest can lead to myocardial contusion or other cardiac damages. Immediate assessment and intervention are crucial for reducing morbidity and mortality associated with this traumatic injury.

Other conditions such as cardiac tamponade (A) and aortic disruption (C) could also present with chest pain but are less likely given the ECG findings of ischemic changes. A pulmonary contusion (D) primarily affects the lungs rather than the heart, although it could also result from a chest trauma and present with similar respiratory symptoms.

The elevated troponin is a marker of cardiac injury, often associated with myocardial infarction (MI), but in the context of trauma, it is more indicative of a blunt cardiac injury. The management of such an injury may include close cardiac monitoring and treatments ranging from supportive care to surgical interventions, depending on the severity of the injury.

Answer 2

In the context of a motor vehicle collision, chest pain, shortness of breath, sinus tachycardia, ischemic changes on ECG, and elevated troponin levels are suggestive of a blunt cardiac injury. While other injuries should be considered, the specific symptoms presented align closely with BCI. The correct answer is option: B. Blunt cardiac injury

Step-by-step explanation:

A patient presenting with chest pain, shortness of breath following a motor vehicle collision, sinus tachycardia, ischemic changes on an electrocardiogram (ECG), and an elevated troponin level should raise high suspicion for blunt cardiac injury (BCI). This condition is characterized by the heart muscle being bruised or damaged as a result of the impact, which can lead to abnormal heart rhythms, heart muscle rupture, or long-term complications like congestive heart failure. The ECG findings and elevated troponin are indicative of heart muscle damage, which is a hallmark of BCI.

Options such as cardiac tamponade and pulmonary contusion might also be considered; however, ischemic changes and elevated troponin are more directly related to BCI. Cardiac tamponade typically presents with hypotension and jugular venous distension, and the diagnosis often involves the detection of excess fluid in the pericardial cavity that restricts the heart's movements.

Aortic disruption is usually considered when there is a widened mediastinum on chest X-ray. A pulmonary contusion focuses more on injury to the lung tissue resulting in breathing difficulties, which can coexist with BCI but does not typically result in ischemic ECG changes or elevated troponin on its own.