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Post by pbruss on Oct 9, 2014 14:29:40 GMT -5
Case i just saw in Cambridge with Authmany sititing next to me studing for her boards.
Limited History. EMS called for unresponsive. Unwhitnessed arrest with aprox down time of 30 min. King airway and IO line placed by EMS. PEA on arval, intubated, 2 round of EPI, 2grams of Calcium, one amp bicarb and ROSC achieved.
EKG is attached.
what is your Interp and treatment plan? Attachments:
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Post by Bjs04f on Oct 14, 2014 9:49:13 GMT -5
As amal said there are 2 types of pea wide and narrow. Wide is metabolic more often then mechanical so hyper k, TCA or sodium channel blockers. So continue with bicarb and calcium gluconate, intermixed with continuing CPR and epi. Getting rosc shows this was succesful management, need pts med list, drug habits, etc. Let's get a tox,BNP for electrolyte disturbances
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Post by pbruss on Oct 16, 2014 22:22:33 GMT -5
very good, there are signs of a metabilic process on the ekg. do you see anything else? signs of infarction or ischemia? by the way i have you gift card next time i see you
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Post by Bjs04f on Oct 17, 2014 16:00:48 GMT -5
II, III, AVF look to have concordant ST elevation with that BBB
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Post by pbruss on Oct 18, 2014 5:55:12 GMT -5
on the right track. anyone else. hint : how do you establish the isoelectric point on the ekg which determins what is elevation and what is depression?
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Post by Bjs04f on Oct 18, 2014 15:08:13 GMT -5
compare t to P interval, during which there is no electrical activity. The repolarizaion is done, and the atrial depolarizaton has yet to start
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Post by pbruss on Oct 19, 2014 2:43:04 GMT -5
you are exactly right, however the concordance/discordance does not apply to RBB, only LBB or ventriculr paced. so 2, 3, AVF is st depression and there is elevation present in 1 and AVL and V2 to V4 inticating acute infarction. attahced is the ekg with the base line marked in red. Attachments:
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Post by kemple on Oct 19, 2014 12:13:57 GMT -5
good example of finding that T-P, sometimes people are tricked by a wandering baseline (my own made up term i think) and you have to be careful for that.
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