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Commotio Cordis CC

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Lacrosse, hockey, softball, soccer, karate, football. Rare but happens ... Blunt Non-penetrating Hockey Puck. 15 year old hockey player raises arms in front of ... – PowerPoint PPT presentation

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Title: Commotio Cordis CC


1
Commotio Cordis (CC)
  • Cardiac Concussion

2
What is Commotio Cordis?
  • 1879
  • Sudden, low-energy, non-penetrating impact to the
    precordium resulting in immediate cardiac arrest
    and sudden death from ventricular fibrillation
  • Young athletes, occurring during sports
    participation
  • Ventricular fibrillation
  • Cases reported

3
Scientific Explanation
  • 15 millisecond window of the upslope of the
    T-wave
  • 1 of cardiac cycle
  • Vulnerable phase of repolarization
  • Heart Block, Bundle Branch Block, ST-segment
    elevation
  • Other theories

4
MOI
  • Most common
  • Pitched, thrown, batted
  • Other instruments of destruction
  • Hockey pucks, lacrosse balls, players helmet,
    heel of hockey stick, karate kick, bodily
    collision

5
Where do we find CC occurrence?
  • Most often Baseball
  • Other high risk sports
  • Lacrosse, hockey, softball, soccer, karate,
    football
  • Rare but happens
  • Basketball, cricket, martial arts, boxing, street
    fights, motor vehicle accidents

6
Population of Incidence
  • Healthy athletes
  • Young, ages 4-18 years
  • Chest wall pliability
  • Slower reflex
  • Less aware of risk/less training
  • Chest Configuration
  • Male predominately 95
  • Majority of victims white 87

7
Findings after a CC Event!
  • Initial Findings
  • Immediate unconsciousness
  • Brief consciousness
  • NO, NO, NO
  • No identifiable structural injury
  • No cardiac injury or thoracic abnormalities
  • No abnormal laboratory, imaging, or histologic
    findings
  • Abrasions/Bruising

8
Variables
  • Precise Synchronization
  • Energy of Impact
  • Hardness of the Impact Object
  • Location of the Impact
  • Magnitude of Chest Compression
  • Viscous Deflection
  • Size of the Contact Area

9
Survival Statistics ? ? ?
  • What will benefit a positive outcome
  • Insufficient Acknowledgment
  • Survival Rate without Defibrillation
  • Resuscitation More Difficult than expected
  • Successful Resuscitation
  • The inevitable

10
Preventative Measures
  • Safety Balls
  • Protective Equipment
  • On Deck Circle
  • Education
  • Automated External Defibrillators (AEDs) !!!

11
Blunt Non-penetrating Hockey Puck
15 year old hockey player raises arms in front of
the goal to stop shot, receives a small
mid-precoridial contusion, the shot proved to be
fatal!
12
Protective PaddingDoes it really help?
Looks good so far
But, when the victim lifts his arms, the
protective padding leaves the heart vulnerable
13
References
  • Ashrafian, Hutan. (2003). Sudden Death in Young
    Athletes. The New England Journal of Medicine.
    3492464-2465.
  • Commotio Cordis. (2003). Tufts-New England
    Medical Center.
  • Crampton, Richard. (2001). Arrhythmias and Sudden
    Death in Athletes. The New England Journal of
    Medicine. 344535.
  • Curfman, Gregory. (1998). Fatal Impact
    Concussion of the Heart. The New England Journal
    of Medicine. 3381841-1843.
  • Maron, Barry. (2003). Sudden Death in Young
    Athletes. The New England Journal of Medicine.
    3491064-1075.
  • Maron, B., Strasburger, J. (2002). Commotio
    Cordis. The New England Journal of Medicine.
    3471248.
  • Vincent, Michael. (2003). Commotio Cordis. The
    Physician and Sportsmedicine. 28(11).
  • Yabek, Steven. (2004). Commotio Cordis.
    eMedicine.com.
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