[Ventricular rupture after blunt thoracic trauma]

In a collision with a motor-car, a pedestrian suffered multiple injuries and a blunt trauma to the thorax. Immediately after the accident, the patient was haemodynamically instable and needed resuscitation several times, without lasting success. The coroner's office found that cardiac tamponade from a ruptured right ventricle was the cause of death. The incidence of ventricular rupture due to blunt trauma in motor-car accidents is about 10 to 15%. Since definite treatment is not possible at the site of the accident, the patient must be taken immediately to a cardio-surgical hospital after initial stabilization. Unfortunately, preclinical diagnosis of ventricular rupture is difficult. In this context, the increasing availability in ambulances of a 12-channel ECG, a highly sensitive diagnostic tool, represents significant progress. Cases like the one described above should be discussed at mortality conferences of pathologists, coroners and emergency physicians to increase awareness of this problem. Only if the possibility of cardiac rupture is considered and ruled out early in cases of massive multiple injuries with haemodynamic instabilities, will decrease the apallingly high lethality figures.