A teenager involved in a motor vehicle collision with abnormal ECG

Written by Pendell MeyersA teenager was involved in a motor vehicle collision and presented to the Emergency Department via EMS altered and potentially critically ill. He was intubated for altered mental status. Chest trauma was suspected on initial exam. Here is his initial ECG around 1330:What do you think?The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. It is very unlikely that a previously healthy teenager would have such disease of the conduction system, bringing up the possibility of blunt cardiac injury in this clinical setting.Trauma CTs showed a " mildly displaced sternal fracture and a small retrosternal hematoma. " There were no radiographic injuries noted in the head/spine/abdomen/pelvis CTs.Initial high sensitivity troponin I: 3,830 ng/L (URL 20 ng/L for men)1445:Similar to initial ECG.1520:The QRS has narrowed slightly, but the morphology is similar.Troponins:3,830 ng/L4,098 ng/L1,343 ng/LEcho:LV: normal cavity size and thickness. Systolic function is mildly reduced by visual assessment. EF 45%, with mild global hypokinesis. RV: Cavity size normal. Systolic function normal by visual assessment only, unable to visualize well for further characterization.1900:RBBB and LAFB are almost fully resolved.2300:QRS now within normal limits.No other significant injuries were found. The patient did well and was discharged. No cardiac MRI was done. Hopefully a repeat echocardiogram will be performed outpat...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs