Commotio cordis. How does an NFL football player, a Buffalo Bills player, who collides with another player go into cardiac arrest right in the middle of a football game? Well, it’s suggested this is commotio cordis. Now, what is it? What is it? John, help me understand what that is. Sure. Now, to do that, we’ve got to go back in time a little, but we have to go back in time to Advanced Cardiac Life Support. Now, Advanced Cardiac Life Support for my practicing PAs, nurse practitioners, docs, you guys know it’s a course that we have to take every two years, so we can take care of people who are being resuscitated, like the Buffalo Bills player.
I taught that course for a while. I taught another course called Advanced Cardiac Life Support. But more importantly, I’ve taken care of a lot of people in cardiac arrest. Now, old school ACLS, we taught a technique called the precordial thump. Now, what was the precordial thump? The precordial thump is where you take your hand and beat on their chest one time. Now, what did that do? Well, when someone’s in cardiac arrest, they go into one of three major buckets. One bucket is asystole or cardiac standstill, there’s no activity whatsoever. One bucket is where they’re dead, but there’s something a little bit weird on the monitor. We call it pulseless electrical activity. So they’re dead, but it’s not a structured rhythm that we can shock.
Now, the third reason they go into cardiac arrest is what we call lethal arrhythmia, and that’s what we put into a bucket of pulse is V-tach or V-fib. These are the three buckets that people go into when they die. Now, whenever someone’s in cardiac arrest, man, we want it to be the lethal arrhythmia. We want the pulse to be V-tach or V-fib because then we can shock them out of it. That’s what we want. Now, a precordial thump was something we used to teach because when you whack someone on the chest, you give them a shock. That’s a very small shock. So you take mechanical energy and it converts it into about a 20 joule shock, which is a small shock. Now, if someone went into the arrhythmia, V-tach or V-fib, maybe we can convert them out of it. Now, we don’t teach that in ACLS anymore.
Now, with precordial thump, there’s three indications for it. One is you have to witness someone go down. So it means you’re in close proximity to them, meaning that the thump with a low amount of energy might convert them. Number two, they have to be dead. They were in cardiac arrest. And number three, there cannot be an AED anywhere nearby. So there’s no rule for a precordial thump in the hospital because there’s always an AED, there’s always a crash cart somewhere. But if I’m on a boat and someone goes into cardiac arrest on my boat, I don’t have an AED, I can give them a thump. Now, they have to be dead. They have to be in cardiac arrest. Because if we whack them on the chest, we could kill them with this commotio cordis. Now, John, what do you mean by that? Help me understand that.
Now, during the cardiac cycle, there are three major parts. You have a P wave, and that’s when the atrial depolarizes. You have the QRS complex, that’s when the ventricles depolarize, the bottom of the heart. And then you have the ventricles that recharge itself, it repolarizes. That’s your T wave. Okay? Now, the T wave, the heart’s really vulnerable. It’s really vulnerable, which means if someone gets a shock of electricity on that T- wave, they die. I think it’s like Top Gun number one where Maverick and Goose’s plane crashed. That’s what happens to the heart. If there’s a bolt of electricity that hits the T wave, the patient dies. So in medicine, we call it the R-on-T phenomenon. Now, if someone gets hit on the chest at that time, and it only happens the cardiac cycle is so small that it would have to be in an incredibly unlucky window of time.
If they get hit on the chest, that mechanical energy converts to electrical energy, they get a 20 joule shock. And if it happened right on the T wave, they would die. Now, that’s why when we resuscitate a patient in a hospital. So if we have a patient who’s got an unstable tachyarrhythmia, and we do a synchronized cardioversion. We synchronize it, so it shocks them on the peak of the R wave and doesn’t hit the T wave. So a synchronized cardioversion is specifically done, so that doesn’t happen. So if you struck somebody in the chest at the perfectly right time, unfortunately if it hits on the T wave, you could kill them. Right? So that’s what is believed happened. John Bielinski from CME4LIFE. Our whole goal is to help you maximize your mind. And if how this was taught works for you, you should see our other videos or our CME programs.