You respond to an 18 year old male who has been assaulted with a baseball bat. He was hit in the chest. He is unresponsive, apneic, and pulseless. The condition is likely related to:

• A. Shock
• B. Commotio cordis
• C. MI
• D. PE

Answer: (B)

Commotio cordis is a sudden cardiac arrest caused by a blunt chest impact during a vulnerable moment of the heart’s electrical cycle. An impact to the chest, especially in a young person, can disrupt ventricular repolarization and trigger ventricular fibrillation. When this happens, the heart stops effectively pumping, leading to immediate loss of consciousness, no respirations, and no pulse—the scenario described. This is distinct from a myocardial infarction, which results from coronary artery disease and usually isn’t precipitated by a chest blow in an otherwise healthy teenager. A pulmonary embolism presents differently, with abrupt chest symptoms like shortness of breath and chest pain, and shock as a general term doesn’t pinpoint the mechanism here. In practice, the response is rapid CPR with early defibrillation, since the rhythm is typically a shockable ventricular fibrillation.