Diagnosis is difficult due to spectrum of clinical disease and lack of adequate test in the ED
Physical exam
Majority (75%) of patients will have evidence of chest wall trauma
Imaging
CXR and CT Chest are neither sensitive nor specific for<unk> , but may show other blunt<unk>  injury
Echocardiography may be useful - contusion will show localized wall motion abnormality
ECG - may be normal or show non-specific abnormalities
most common abnormality in order (sinus tachycardia, PVCs, atrial fibrillation)
81–95% of life threatening ventricular arrhythmias and acute<unk>  failures occur within the first 24–48 hrs<unk>  enzymes (Troponin, CK-MB)
CK-MB is neither sensitive nor specific
Troponin is specific for<unk>  injury, but not sensitive for<unk> 
Majority (75%) of patients will have evidence of chest wall trauma
CXR and CT Chest are neither sensitive nor specific for<unk> , but may show other blunt<unk>  injury
Echocardiography may be useful - contusion will show localized wall motion abnormality
most common abnormality in order (sinus tachycardia, PVCs, atrial fibrillation)
81–95% of life threatening ventricular arrhythmias and acute<unk>  failures occur within the first 24–48 hrs
CK-MB is neither sensitive nor specific
Troponin is specific for<unk>  injury, but not sensitive for<unk>
Cardiac contusion
Airway/Pulmonary
Pulmonary contusion
Bronchial injury
Traumatic intracerebral hemorrhage
Diaphragmatic trauma
Subdural empyema
Hemothorax