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Post by pbruss on Aug 9, 2015 14:30:04 GMT -5
30 yo male come in by EMS for seizure witnessed at work. no history of seizures. mildly post ictal but alert talking and interacting appropriately. tachy and hypertensive. ct brain neg. prolactin elevated but all blood test normal. he wont give a urine sample. he denies any drugs. attached is his ekg from this visit and one from 2 years ago. what do you think? what would you do? Attachments:
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Post by tyson on Aug 9, 2015 21:22:04 GMT -5
I am assuming the second EKG was the most recent one, as it is the one that is tachycardic. In this case without knowing if he had ingested any drugs but with slight QRS widening and definite lengthening of the QT interval I would go ahead and treat with a little bicarb and even throw a couple grams of magnesium at him, fluids and even check abg.
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Post by kemple on Aug 9, 2015 22:30:15 GMT -5
Second EKG almost looks like Brugada. Has the hump in the ST segment. I would admit for EP.
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Post by pbruss on Aug 11, 2015 18:48:18 GMT -5
well played tyson. it is very subtle but i left the computer read out for a clue. the qrs is greater then 120 and the QT is a little longer and he has a slight r wave in avr which is new. i gave him one amp of bicarb and repeated the ecg right away and those abnormalities improved significantly. turns out he was abusing someting called Kratom. its a tea leaf from central america that at high doses actls like morphine and cocaine. one hour later the ekg abnormalities came back so i started him on a bicarb drip and got him addmitted. interesting case.
main point is thatit does not matter what he took, it acts just like TCA with the seizure and ekg and the treatment is sodium bicarb.
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