FIGURE 115.7 Pericardiocentesis is performed by inserting a 20-gauge spinal needle below the xiphoid process at a 45-degree angle toward the left shoulder Disposition In one study, all children who developed heart failure or life-threatening cardiac arrhythmias during their hospital course initially presented to the ED either in shock or with an arrhythmia Based on this, patients with suspected isolated myocardial contusion can be monitored in the ED or hospital If no arrhythmias develop on EKG, they can be safely discharged home Children with any arrhythmia require admission to a bed with continuous cardiac monitoring More significant cardiac injuries necessitate admission to an intensive care unit, with interventional cardiologists or cardiac surgeons available to provide emergent interventions as needed INJURIES OF THE AORTA AND GREAT VESSELS CLINICAL PEARLS AND PITFALLS