|
|
Post by pbruss on Sept 18, 2014 7:41:06 GMT -5
79 yo male with 1 hour of substernal crushing chest pain with nausea diaphoresis and sob. The first attahcment is his ekg in the ER and the second attachment is his old EKG. Please list your interpritation and managment. Attachments:
|
|
|
|
Post by Bjs04f on Sept 18, 2014 10:40:32 GMT -5
Big things I see right away are the interval development of deep Q waves in lateral leads I, and qS complex in V5,6. There is also elevated ST in V5-6. The development of a RBBB. Overall this looks like a bad EKG, and vastly different from prior EKG. With that being said and his symptoms, call cath lab.
|
|
|
|
Post by pbruss on Sept 19, 2014 5:48:30 GMT -5
he does need the cath lab for the findings you mentioned. however, there is a more concerning finding in the EKG as far as infarction goes. can anyone see it?
|
|
|
|
Post by kemple on Sept 21, 2014 15:12:08 GMT -5
Getting a block and qrs widening, put some patches on for the impending arrhythmia is my thought.
|
|
|
|
Post by pbruss on Sept 23, 2014 19:41:02 GMT -5
De Winter's t waves in precordial leads. See attached slide fron NEJM |
|
|
|
Post by kemple on Sept 24, 2014 11:49:32 GMT -5
Now I see it. Could be really hard to differentiate if pt is hyperkalemic as well. Good EKG as usual.
|
|
