Get insights on chest injuries & emergencies from ER physician Dr. Dacia Ticas. Learn about red flags and vital info for athletic trainers.

Q: What drew you to emergency medicine, particularly regarding chest injuries and emergencies?

A: I liked everything and wasn't sure what to commit to. Emergency medicine allowed me to experience a bit of everything, including a wide range of chest injuries.

Q: As an ER physician, what makes you nervous, especially concerning severe chest injuries in children?

A: Pulseless children are concerning. Severe cases with children, such as swelling or edema of the airway where a cricothyrotomy might be necessary, are also very serious.

Q: For athletic training, what are red flags indicating something is truly wrong with an athlete, beyond just being out of shape, regarding potential chest injuries?

A: Being out of shape typically presents as shortness of breath without actual struggle or severe chest pain. Red flags for chest injuries include pale or cyanotic appearance, complaints of severe chest pain, and a visible struggle to breathe.

Q: Is an on-field ultrasound something athletic trainers can perform, or is a physician required for assessing chest injuries?

A: A physician would be required. While we wish it were seen more often, on-field ultrasound has tremendous value in clarifying life-threatening chest injuries.

Q: As athletic trainers are the initial contact for chest injuries, what essential information do you need from us?

A: We will conduct our routine workup regardless. Key information includes what actually happened—e.g., getting hit in the throat versus the chest—whether they collapsed or lost consciousness, and how the patient initially presented and communicated their complaints.

Q: What kind of chest injuries might take a day or two to fully manifest or be definitively diagnosed?

A: Cardiac and pulmonary contusions can take time to develop. Life-threatening issues are typically identified through labs on the day of the incident.

Q: Can you explain Commotio cordis in the context of chest injuries?

A: Commotio cordis involves the ventricles going out of whack due to a flux of ions being disrupted, which is a chemical issue. This happens in a fraction of a second, as highlighted by the Damar Hamlin incident, which brought athletic training to the forefront for chest injuries.

Q: When an athlete experiences chest pain after a hard tackle, when is immediate removal necessary, and when can we "wait and see" for bigger issues related to chest injuries?

A: Often, if you ask an athlete if they can return to play a few plays later, they might indicate they cannot or develop a specific spot of noticeable pain. Lingering pain for a few plays, rather than generalized pain, may be a sign for removal due to a bigger issue, particularly with chest injuries.

Q: Could you share a surprising ER story related to chest injuries?

A: There are many stories. Early in my career, seeing a 4x4 through a chest wall, yet the internal organs were intact, was shocking. As I progressed, medical mysteries became more enticing. DJ Harden's aortic injury after a chest hit, and assessing patient consciousness and bilateral pulse equality, are all crucial in emergency medicine for chest injuries.