ERDoc Posted October 6, 2008 Share Posted October 6, 2008 I'm going with commotio cordis. When I was in NY we had a few kids that this happened to and caused a big political brouhaha that resulted in every cop car having a defib. Good thoughts on what to look for on the EKG. The thing I was getting at was to look for delta waves. Though it does not happen often, WPW can lead to sudden cardiac arrest. As for the meds, I would hold off and monitor for a while. This is a strong healthy kid and not an old, debilitated cardiac pt. This kid will more than likely be able to stabilize himself once we get him out of vfib. Let's be sure not to give him any more blows to the chest. Link to comment Share on other sites More sharing options...
chbare Posted October 6, 2008 Author Share Posted October 6, 2008 Looks like we nailed the diagnosis. As mentioned earlier, commotio cordis is the diagnosis. However, this problem is very different from say thoracic trauma that causes a myocardial contusion? What are some of the defining characteristics of commotio cordis? Does ventricular fibrillation occur because of direct myocardial insult? Take care, chbare. Link to comment Share on other sites More sharing options...
emt322632 Posted October 6, 2008 Share Posted October 6, 2008 Seems to me like the diagnostic tests support the diagnosis of commotio cordis. This was an otherwise normally healthy individual (I think, did we get an accurate history from the family? If not we should!) Who sustained a direct insult to the chest which resulted in v-fib. The emedicine article that was posted earlier, http://www.emedicine.com/ped/TOPIC3019.HTM seems to support the diagnosis here. This kid was just unlucky enough to get hit in the chest in that 15-30 millisecond window. Link to comment Share on other sites More sharing options...
ERDoc Posted October 6, 2008 Share Posted October 6, 2008 chbare, looks like you've been doing some online CME, lol. :wink: Link to comment Share on other sites More sharing options...
chbare Posted October 6, 2008 Author Share Posted October 6, 2008 Shameless, I know. Take care, chbare. Link to comment Share on other sites More sharing options...
ERDoc Posted October 6, 2008 Share Posted October 6, 2008 It is still a great learning case. Link to comment Share on other sites More sharing options...
Arizonaffcep Posted October 6, 2008 Share Posted October 6, 2008 Looks like we nailed the diagnosis. As mentioned earlier, commotio cordis is the diagnosis. However, this problem is very different from say thoracic trauma that causes a myocardial contusion? What are some of the defining characteristics of commotio cordis? Does ventricular fibrillation occur because of direct myocardial insult? Commotio cordis is from R on T, so to speak, correct? Where the electrical activity is not generated by the heart itself, but rather the energy transferred from contact of the chest with an object. Same way a precordial thump is supposed to work. Vs. actual damage/contusion to the heart tissue itself. BTW, ERDoc, you need to be careful with your location. Here in Tucson, the 3 most dangerous things to do are: 1., eat a burrito, 2., walking home from church, 3., minding your own business. When done in combination...boy howdy watch out! GSW city! Safest things to do, be very nosy, don't go to church (or if you do, drive) and stay away from cheap mexican food! Link to comment Share on other sites More sharing options...
firedoc5 Posted October 7, 2008 Share Posted October 7, 2008 So, what does everybody think? Lidocaine or amiodarone following successful defibrillation? We need to consider the risks and benefits of giving these agents. One of the goals following ROSC is to try to stabilize cardiac activity. Did the patient's cardiac activity stabilize without the use of agents rather quickly? While I will not say you are incorrect in giving agents, do we need to give every V-fib arrest these agents? Can we actually monitor and provide supportive care? A little "benign neglect" perhaps? At least with my "old school days", any successful defib/cardiovert received an anti-dysrhythmic. Not only has the heart had complications before the defib, then a huge "zap" with the defib. Those ventricles are going to be irritated. Need to "calm" them down. Matt, I'll go half way with you. Good argument on the Atropine. But after re-thinking, I'd only give him 0.5 mg instead of 1 mg. since he did now have a rhythm. If his rate does increase spontaneously, there is still no harm with what Atropine you have given. Hanging a Lido. drip would only be if transport was more 20 mins. Link to comment Share on other sites More sharing options...
hammerpcp Posted October 15, 2008 Share Posted October 15, 2008 Interesting case. I learned a new word too. I have always heard this phenomenon referred to as "R on T" (waves). Link to comment Share on other sites More sharing options...
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