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EKG
May 15, 2014 0:54:58 GMT -5
Post by pbruss on May 15, 2014 0:54:58 GMT -5
52 yo male siged out to me yesterday wheni was moonlighting at an outside hospital. report was "has new onset a fib and some chest pain. when the labs all come back just call the hospitalist to get him admitted" attached is the EKG. what do you think? Attachments:ekg.bmp (583.04 KB)
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EKG
May 15, 2014 8:08:22 GMT -5
Post by mcclain on May 15, 2014 8:08:22 GMT -5
Anterior STEMI, LAD occlusion? Did the other doc look at the EKG?
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Post by slevittMD on May 15, 2014 9:54:58 GMT -5
That is some serious avr elevation with diffuse depressions everywhere else. Triple vessel, L main, some kind of high up occlusion. Was it an ER trained doc that signed this out? Even ignoring avr, those are some seriously concerning depressions. Maybe a cardiologist moonlighting in the ER?
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EKG
May 15, 2014 13:43:07 GMT -5
via mobile
Post by gigantor on May 15, 2014 13:43:07 GMT -5
Couldn't agree with levitt more. I think we've all heard enough about it to always look at aVr when I guess it's new to everyone else. Still, even without that I don't buy demand ischemia with the depressions elsewhere. That's a scary EKG to me.
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EKG
May 15, 2014 19:29:21 GMT -5
Post by pbruss on May 15, 2014 19:29:21 GMT -5
yeah, this was a scary case. the physician was a board certified doc and the ekg was doccumented as "a-fib with normal rate, non-specific ST waves, nondiagnostic". luckily the patient had just come in 10 mins earlier by ems and the ekg was the only thing done so far. we flew this guy to Colombus which was the closest Cath lab. he got intubated before he left and arrested twice enroute. had 100% LAD. 15 min after he left the lab called with a critical result of trop of 120.
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EKG
May 16, 2014 10:26:28 GMT -5
Post by mcclain on May 16, 2014 10:26:28 GMT -5
That's. Wow. Yeah. Did the guy survive? I think I would defecate mortar building blocks if I saw that first thing on arriving at my shift.
ETA: AS A SIGNOUT WITH THAT KIND OF CRAZINESS. Just as a regular patient arrival, fine. It happens. But someone else IGNORED that EKG? Yikes.
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EKG
May 19, 2014 21:28:29 GMT -5
Post by kemple on May 19, 2014 21:28:29 GMT -5
That was definitely a concerning EKG from the beginging. Those aVR ST Elevations were severe with reciprocal V5 V6 depressions that were also severe. I agree that I would have been thinking proximal or multi vessel disease. Just out of curiosity did you start him on heparin or anything prior to transport?
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EKG
May 20, 2014 21:58:46 GMT -5
Post by pbruss on May 20, 2014 21:58:46 GMT -5
i did lovenox, 30 mg IVP with 1MG/kg SQ. with is prefered eventhough all the cards here use heparin. its better, easier, and he didint need a drip en route.
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