CXR
Mediastinum widening is only suggestive of an aortic<unk> 
Lack of widening does not rule out aortic<unk> 
CTA
Imaging study of choice
FAST exam
First view of FAST in penetrating<unk>  should be pericardial
Pericardial fluid detection (Sn 100%, Sp 97%)
ECG
NPV for a normal ECG is 80-90%
Not as sensitive for right-sided<unk> es
Troponin
Trend in all patients
Troponin elevation alone is only 23% sensitive for<unk> 
Combination of normal ECG and normal troponin has NPV of 100% for significant<unk> 
Troponin elevation can stem from catecholamine-induced stress, hypovolemic shock with reperfusion<unk> , oxidative<unk> , bacterial or viral toxins or microcirculatory dysfunction. Look at history and patient exam findings.
Mediastinum widening is only suggestive of an aortic<unk> 
Lack of widening does not rule out aortic<unk> 
Lack of widening does not rule out aortic<unk> 
Imaging study of choice
First view of FAST in penetrating<unk>  should be pericardial
Pericardial fluid detection (Sn 100%, Sp 97%)
NPV for a normal ECG is 80-90%
Not as sensitive for right-sided<unk> es
Trend in all patients
Troponin elevation alone is only 23% sensitive for<unk> 
Combination of normal ECG and normal troponin has NPV of 100% for significant<unk> 
Troponin elevation can stem from catecholamine-induced stress, hypovolemic shock with reperfusion<unk> , oxidative<unk> , bacterial or viral toxins or microcirculatory dysfunction. Look at history and patient exam findings.
Level 1 evidence
ECG to be performed on all patients suspected of<unk>  (looking for various ECG changes including ischemic changes, nonspecific ST changes, arrhythmia, conduction blocks, though most common is sinus tachycardia).
Level 2 evidence
If new ECG changes consider admission for 24 hours telemetry and serial ECG/troponin
If normal (or stable) ECG and normal troponin I (at any time),<unk>  is ruled out
If hemodynamically stable, emergent bedside echo to assess for pericardial fluid
Presence of sternal fracture alone does not predict presence of<unk>  and should not prompt monitoring if normal ECG/Troponin
Level 3 evidence
Troponin I should be measured routinely for patients with suspected<unk> ; if elevated patients should be admitted to a monitored bed with serial levels
ECG to be performed on all patients suspected of<unk>  (looking for various ECG changes including ischemic changes, nonspecific ST changes, arrhythmia, conduction blocks, though most common is sinus tachycardia).
If new ECG changes consider admission for 24 hours telemetry and serial ECG/troponin
If normal (or stable) ECG and normal troponin I (at any time),<unk>  is ruled out
If hemodynamically stable, emergent bedside echo to assess for pericardial fluid
Presence of sternal fracture alone does not predict presence of<unk>  and should not prompt monitoring if normal ECG/Troponin
Troponin I should be measured routinely for patients with suspected<unk> ; if elevated patients should be admitted to a monitored bed with serial levels
Blunt cardiac injury
Airway/Pulmonary
Penetrating cardiac injury
Bronchial injury
Traumatic cardiac arrest
Diaphragmatic trauma
Spinal shock
Hemothorax