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Post by pbruss on Jan 5, 2015 7:28:02 GMT -5
patient I saw with barkley. 64 yo man with COPD, HTN, HLD, CAD had acute onset sob about 30 min after taking over the counter cold medicine. comes in by EMS hypoxic, tachycardic, hypertensive, sever reps distress, confused and lethargic. he can't give any history. we intubated him and his EKG is attached. what is your interp and treatment? Attachments:
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Post by Bjs04f on Jan 7, 2015 13:28:46 GMT -5
At quick glance went wide complex regular vtach it is lets procainamide. However spent a few more minutes looking and I feel that this is more likel a LBBB based on the large R in I, and deep v1-3 S waves, and V6 S wave. The one thing I notice then is the circle, which seems to be showing St depression concordant with qrs which would meet criteria for STEMI in LBBB.
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Post by pbruss on Jan 8, 2015 6:45:01 GMT -5
bravo. i forgot about the circle, sorry. barkley was also concerned about inapropraite discordinance in the pre-cordial leads. she faxed the EKG to the cardiologist on call (who was not an interventionalist) who agreed with cath lab activation. however the interventtionalist on call didi not feel the patient needed an emergent cath. his trops were elevated. he is still intubated, trops trending down, was positive for influenza A, no cath yet, echo read as no focal wall motion abnormalities but very "limited study..wiith poor image quality" so not 100% accurate.
also, strong work by barkley on a difficult intubation. short fat neck with secretions everywhere.
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