This handout is for cardiac tamponade — blunt chest trauma (mva, fall, sternal blow). Your care team identified this based on: high-speed mvc with steering-wheel impact + chest pain / dyspnea / hypotension → blunt cardiac injury screen (atls §thoracic; east 2012 pmid 23114492).
Other reasons your team may use this plan: fall from height >3 m with thoracic landing + new hypotension or muffled heart sounds → traumatic hemopericardium suspected (atls); direct sternal blow (assault, sports, low-velocity mvc) + new dyspnea/hypotension → blunt cardiac injury workup (stafford ann thorac surg 2017); pericardial fluid on e-fast (subxiphoid view) in blunt-trauma context — assume traumatic hemopericardium until proven otherwise (rozycki ann surg 1998).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| normal saline | 500-1000 mL bolus then minimize per damage-control resuscitation | IV | rapid bolus then reassess | Bridge preload until blood products available; minimize crystalloid in trauma to avoid dilutional coagulopathy (ATLS damage-control) |
| norepinephrine | 0.05-0.5 µg/kg/min titrate to MAP ≥65 (or permissive 80-90 SBP per damage-control) | IV | continuous | Bridge only — does not address obstruction; concurrent hemorrhagic shock often present (Roy JAMA 2007 PMID 17456823) |
| tranexamic acid | 1 g IV over 10 min then 1 g over 8h | IV | bolus + infusion | CRASH-2 PMID 20554319 — mortality benefit if administered within 3h of injury in trauma with significant hemorrhage; class evidence extends to traumatic hemopericardium |
| protamine | 1 mg per 100 U residual UFH (max 50 mg single dose) | IV | slow IV over 10 min | Reverse UFH; partial reversal of LMWH (~60%); ESC 2015; standard reversal in active bleeding |
| phytonadione | 10 mg IV slow over 10 min | IV | single dose | Vit K reverses warfarin synthesis defect; works over 6-12h (Bhatt Circulation 2018) |
| 4-factor prothrombin complex concentrate | 25-50 U/kg based on INR | IV | single dose | Immediate factor replacement for warfarin reversal in major bleeding (Bhatt Circulation 2018) |
| idarucizumab | 5 g IV (2 × 2.5 g vials) | IV | single dose | RE-VERSE AD (Pollack NEJM 2017 PMID 28793172) — complete dabigatran reversal within minutes |
| andexanet alfa | low or high dose per agent + dose + timing per ANNEXA-4 protocol | IV | bolus + 2h infusion | ANNEXA-4 (Connolly NEJM 2019 PMID 30730782) — anti-FXa reversal |
| acetaminophen | 650-1000 mg q6h scheduled | PO/IV | q6h | NSAID avoidance in immediate post-trauma / post-op due to bleeding + AKI risk; opioids titrated per pain |
Plan: Blunt cardiac trauma → tamponade — damage-control resuscitation + bridge drainage + surgical repair (ATLS; EAST 2012; CRASH-2)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Cardiology + trauma surgery shared follow-up; echo at 4-6 wk for valve / wall-motion follow-up; cardiac MRI at 4-6 wk if persistent symptoms or echo equivocal; sports/return-to-work clearance per cardiology (Stafford 2017)
Guideline: ATLS 10th edition (American College of Surgeons Committee on Trauma) §Thoracic Trauma + EAST 2012 Practice Management Guideline: Screening of Blunt Cardiac Injury (Clancy J Trauma Acute Care Surg 2012 PMID 23114492) + WSES 2019 position paper on resuscitative thoracotomy (Sartelli WJES 2019 PMID 31867050) + 2015 ESC pericardial diseases guideline §Trauma (Adler EHJ 2015 PMID 26320112) — all current as of 2026-05-15.