40-something male in a head-on Motor Vehicle Collision and Splenic Injury

A 40-something male presents to the stabilization room for evaluation following head on motor vehicle collision (MVC).  Pt was reported restrained driver, hit at city speeds,  with + airbag deployment.The MVC was unquestionably caused by the other car, not by this driver.The patient complained to EMS of chest pain and a prehospital EKG en route was concerning for STEMI.The patient was at all times hemodynamically stable, without evidence of any profuse bleeding.He had an ECG recorded on arrival to the ED:Anterior and Inferior STEMI with diffuse hyperacute T-waves. This ECG really can't be anything else. Takotsubo is on the differential of anterior and inferior STE, but takotsubo just looks different (see some cases below).This must be an occluded" wraparound "LAD (wraps around the apex to the inferior wall) and one would expect an apical wall motion abnormality, as well as probable septal, anterior, and inferior wall motion abnormalities.But acute STEMI in this situation is not necessarily due to plaque rupture and/or thrombus.  It could be due to the trauma,and contusion of the LAD with thrombus or dissection.Further patient history revealed that the chest pain startedfollowingthe crash, and that he had no chest pain previously. Brief review of chart showed no h/o known CAD. DDx was possible aortic dissection or injury, cardiac contusion, LAD dissection, or type I MI w/ plaque rupture.They performed a bedside ED cardiac ultrasound...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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