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Mark: Hi everyone. You know, the whole world just got its first look at Commotio Cordis. Tragically, an NFL player was struck in the chest and his heart stopped. When I saw the play, I knew exactly what it was, because I've seen it before. So today, what is commotio cordis and a little extra on how to protect your kids if they're gonna play contact sports. Starting right now.
Okay, commotio cordis, what is it? Well, this occurs when there's a sudden impact to the heart. It is important to remember. The heart is an electrical pump. It is an electrical pump that runs on electricity. Now, when the heart is beating, it beats all the cells, depolarize, the heart beats, then it relaxes and it resets. It has to repolarize. Beating repolarizing, beating repolarizing.
Let's look at this on an ECG for a minute. So, if we look at our ECG, the QRS represents ventricular contraction. So the heart is beating, then it stops. And then we have this other wave form known as the T wave. And this is the repolarization phase of the heart. Now, within that repolarization phase, there's two separate sections. The first part is known as the absolute refractory period. So if I were to give a charge during that absolute refractory period, nothing would happen because the heart electrically is not prepared to do another shock. Not at all.
However, the back half of the T wave that's known as the relative refractory period, and that's really the dangerous spot. Think about it like this. You're gonna rebuild a six-cylinder motor, right? So you get one cylinder, you gotta start the car, nothing's gonna happen. There's only one cylinder. It's not even prepared to fire them. But put five cylinders in that car and try to start it. You get the old chicky chicky chicky boom and it blows up.
That's what happened here. This is the perfect storm. It is rare. You probably won't see this in your career if you're doing EMS, but it happens and we just saw it on Monday night football. So what happened is this guy took a shot to the chest with sufficient energy at exactly the right moment to throw the heart into V-fib, cheeky cheeky cheeky boom. And that's what happened.
So now instead of the heart beating, he's in a ventricular fibrillation or a V-tach, but essentially the heart is just quivering. Now remember, this is an electric pump. What started as a trauma has now become an electrical problem. That's it. This is an electrical problem, man. And the only thing in the world that's gonna fix this is rapidly defibrillating that heart. That's it. The shock put him into V-fib, we shock him out of it.
A case of commotio cordis doesn't mean that there's something wrong with you. There was nothing that led to this or helped induce this. This is just the perfect storm of events. Let's take a look at some other instances. Now, in this one, we have a karate match going on, and you can see that the victim takes a shot right to the chest with a fist and watch him. He's standing, standing, down he goes. It's just within a few seconds he hits the ground.
So get another example. Here, we're at a baseball game with an umpire. The pitcher throws a fast ball and ricochets off the glove and catches that guy right in the chest. Even with that padding, caught him right in the chest. Walks around for a couple seconds, hits the ground - commotio cordis. The player from the NFL game - saw that that helmet hits him right in the chest. He gets up, few seconds he goes down.
Now again, when the player hit the ground, the treatment is immediate defibrillation. The response was quick. They started CPR and they were able to restart his heart on the field. Remember, this is an electrical problem and the cure is rapid defibrillation. Then they took him off to the hospital for further treatment. I don't know what else happened to this player. I wish him the best in his family, a quick recovery, but that's what happened.
Now, how do you protect your kids who insist on playing contact sports, from this to happen? How do we prevent it? One, don't play contact sports - simple enough. I play guitar. So to protect your kids, wear a chess plate, especially baseball. One of the first instances of commotio cordis in a child was a baseball game. Baseball struck the kid right in the chest. Again, sufficient energy, perfect timing during the relatively refractory period, the kid dropped. The fix? Rapid defibrillation.
Should there be a defibrillator at all youth ball games or contact sports? Absolutely. Absolutely. Will you ever use it for commotio cordis? Probably not. But do you wanna have it for the 63-year-old hotdog-eating-beer-drinking guy up in the stands? You know, just waiting for that coronary. Yes. Have a defibrillator for him.
The next point I want to make for the rest of you has to do with chest compressions. When you saw that player stand up, it was only a few seconds 'till he collapsed. When we stop chest compressions during resuscitation, we're doing the same thing to the patient. We had something going on, we stopped and it fell off a cliff. Now we gotta start again from scratch. That's not good.
Do not interrupt chest compressions unless the patient stands up and goes, Hey, stop beating on my chest. You get ROSC or is terminal, but don't stop chest compressions.
Okay, this has been just a quick review of commotio cordis, what it is, and now, you know, how you can protect your kids a little bit. I'm Mark. Thanks for watching. See you in the next video.