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Question: Cardiac

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Which of the following is most likely to sustain commotio cordis (ventricular fibrillation from blunt chest trauma)?

pemsou5_wp • January 10, 2023

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  1. Kelly January 10, 2023 - 10:55 pm Reply

    C) 17 year old male baseball pitcher wearing a chest protector and impacted by a 35mph “comebacker” hit
    Commotio cordis, although rare, is one of the most common causes of sudden death in athletics. The mechanism is ventricular fibrillation brought on by a direct blow to the heart during a 20-40 msec window of vulnerability during early repolarization. It is postulated to be the cause of Buffalo Bills football player Damar Hamlin’s recent on-field collapse. It is seen primarily in young (91% of cases in < 25 year olds), males (95%), during athletics (75%). Highest risk is impact by a hard smaller (baseball, lacrosse puck) blunt projectile directly over the heart at up to 40 mph. Air-filled objects such as soccer or tennis balls are much less likely to cause commotio cordis. Chest protectors have not been shown to be preventative. Children flipping over bicycle handlebars is classically associated with duodenal hematoma. Here is a video from @EM_RESUS breaking down Damar Hamlin’s event

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