Myocardial Contusion: A Case of Fatal Cardiac Dysrhythmias During Air Medical Transportation.

A 34-year-old male worker suffered from blunt chest trauma after falling from a height of about 10 m. The initial assessment of the emergency physician (EP) indicated that he was confused but recalled the event and had a midthoracic superficial laceration, ecchymosis, tenderness, and severe substernal pain. Because of the urgent need for advanced medical management in a trauma center, the EP coordinated with the nearest trauma center and the air medical crew (AMC) for his evacuation. Blood pressure of 100/55 mm Hg, heart rate of 128 beats/min, respiratory rate of 24 breaths/min, pulse oximetry of 91%, and a capillary refill time of about 2 seconds were the bedside AMC findings. Despite the adverse weather conditions and darkness, the AMC performed the following preflight assessments and preparations for the patient: neck and body fixation, 2 saline locks, intravenous hydration, ketorolac 30 mg intravenously, oxygen mask, a 12-lead electrocardiogram with cardiac monitoring, and echocardiography. During the evacuation, the patient decompensated further from sudden cardiac dysrhythmias, hypotension, loss of consciousness, and apnea. However, despite the difficult and unusual in-flight conditions, the EP performed 30 minutes of cardiopulmonary resuscitation, which was unsuccessful. The forensic report indicated that the fatal cardiac dysrhythmias due to myocardial contusion were a possible cause of death.