Emergency Notes

Dr. Smith's ECG Blog: Right Bundle Branch Block after Blunt Trauma: A Tragic Case.

RBBB never has ST elevation in any lead

ST abnormalities due to myocardial contusion have the highest risk of any ECG finding for adverse outcomes and a higher risk than positive cardiac biomarkers

Recs: for myocardial contusions

1) do a formal echocardiogram on anyone with new significant ECG abnormalities

2) consider an angiogram if there is ST elevation (as here) and a wall motion abnormality

3) measure troponins, as a very high peak troponin would confirm large territory of contusion

3) limit physical activity if there is concern for a large area of contusion.