The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to recognize accurately. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
The emergency department (ED) receives a paramedic call reporting a 10-minute estimated time of arrival for a 17-year-old boy who was found in cardiac arrest after a blow to the chest. The patient has regained spontaneous circulation and is currently awake and alert. A rhythm strip faxed to the ED before the patient's arrival shows ventricular fibrillation, with subsequent conversion to a normal sinus rhythm after defibrillation with 200 J (Figure 1).
The prehospital personnel further report that the patient, a center outfielder for a local baseball team, was trying to catch a baseball when one of his teammates accidentally ran into him, elbowing him in the middle of his chest. The patient immediately dropped to the ground, was unresponsive, and showed no spontaneous movement.
His coach immediately initiated cardiopulmonary resuscitation (CPR) after no pulses were palpated. The paramedics arrived 5 minutes later and, as noted on the rhythm strip, found the patient to be in ventricular fibrillation. One 200-J countershock was administered converting the ventricular fibrillation to a normal sinus rhythm. The patient slowly regained consciousness. He was confused initially and was amnestic to the event.
Upon arrival at the ED, the patient reports mild anterior chest-wall pain but no shortness of breath, palpitations, weakness, or feelings of confusion. He states that he has never before fainted. The patient and his mother report no significant past medical or family history, including any arrhythmias, unexplained sudden deaths, or cardiac structural diseases. He states that he does not have a lower exercise tolerance than his teammates and does not smoke, drink, use medications, abuse illicit substances, or engage in doping practices.
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Cite this: Jansen Tiongson, Lisa Chan. Cardio Case Challenge: A 17-Year-Old in Cardiac Arrest After Collision Playing Sports - Medscape - Dec 16, 2022.