1. Traumatic cardiac arrest is not a "medical" cardiac arrest. In cardiac arrest due to trauma, haemorrhage control, restoration of circulating blood volume, opening the airway, and relieving tension pneumothorax take priority over conventional CPR. Standard ACLS algorithms are largely ineffective in traumatic arrest.

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2. In suspected blunt cardiac injury, get an ECG and troponin. Blunt cardiac injury can be ruled out if both are normal. A sternal fracture alone does not mandate admission if both the ECG and troponin are normal.

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3. Pericardial effusion is diagnosed by CT and FAST. Beck's triad is unreliable. Any penetrating wound to the cardiac box should trigger an immediate FAST. A CT is mandatory in the stable patient. Early surgical intervention, especially within the first hour, is associated with improved outcomes. Pericardiocentesis is a temporising measure only. Ensure rapid diagnosis and rapid escalation to surgery.

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4. Blunt thoracic aortic injury should be considered in any deceleration mechanism. Don’t be reassured by a normal CXR. Get a CT aorta in all these patients. The new grading: Grade I (intimal tear), medical management; Grade II (intramural hematoma), medical management or TEVAR; Grade III (pseudoaneurysm), TEVAR or open repair; Grade IV (rupture), emergency TEVAR or open repair required. Recognize it and move the patient.

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5.  Consider commotio cordis. This is triggered by a blow to the precordium, causing collapse from ventricular fibrillation. Think of it as a cause of sudden cardiac death in sports and blows to the chest.