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Emergency Medicine

Answer 2
  1. ECG. ECG is the recommended screening test for detecting blunt cardiac injury. Nonspecific ECG changes can be present in up to 80% of patients suspected for blunt cardiac injury.2 ECG changes that correspond to clinically significant blunt cardiac injury are usually present at the time of ED presentation. In young, hemodynamically stable patients, a normal ECG precludes the need for further evaluation to detect blunt cardiac injury. The echocardiogram is useful in evaluating cardiac function after blunt cardiac injury but has little utility as a screening tool. CK and CK-MB lack the specificity to detect blunt cardiac injury and can be confounding if there is concomitant skeletal muscle injury. Although troponin is not affected by skeletal muscle injury, the sensitivity is no better than CK.2

    2. Schultz JM, Trunkey DD. Blunt cardiac injury. Crit Care Clin 2004;20:57-70.

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