Interesting Case C Rebus R 3 EM Dr
Interesting Case: C. Rebus R 3 -EM Dr. Rebus. com
Conflict of Interest • None. • Names changed to protect the innocent.
Table of Contents
Introductions http: //www. pengrowthsaddledome. com/seating. html
Day 1, Hour 1, Patient 1 http: //www. cs. uleth. ca/~vpak/spring 2008/gram 3710/
Someone in the Code Room • Clerks: General Approach?
Someone in the Code Room • Clerks: General Approach? – 1* Survey • • • Airway Breathing Circulation Disability MORE HERE
72 yr M, Dizzy on standing • One episode 11: 00 AM. SOB. – • • • Now resolved. Nausea persists. No Hx similar. No chest pain. PMHx: – – – DM 2 2002, Oral Rx CABG x 3 1987 MI: 2005 stent, 2008 stent
Hx cont • Meds – – – – ASA 81 mg OD Atenolol 150 mg OD Clopidogrel 75 mg OD Diltiazem XR 120 mg OD Ezetimbe 10 mg OD Felodipine XR 10 mg OD Furosemide 120 mg AM / 40 mg afternoon Metformin 1000 mg BID
EKG
EKG Idioventricular Rhythm HR 37 No P waves QRS 154 Axis ****ADD****
Idioventricular Rhythm • • • > 6 consecutive ventricular escape beats. HR 30 – 40 QRS >0. 16, similar to PVC
. . . his cardiologist is on the phone. http: //en. wikipedia. org/wiki/File: God 2 -Sistine_Chapel. png
What is happening?
EKG
EKG Sinus bradycardia HR 31 Abnormal P waves QRS 148 Axis ****ADD**** RIGHT BBB LEFT anterior fasicular block
Events • • Atropine x 3 IJ and transvenous pacing Dopamine 5 mcg/kg/min, 10, 15. Cardiology consult at bedside with echo – LVEF <5%, Massive LV thrombus.
Events - Cont. • • 'By the way, I have a burning between my shoulder blades. . . been there all day. ' CODE – – – CPR, epi x 3, Ca++, intubated with glide. 11 minutes. RIP.
Pacing • Indications – Theraputic – correct rhythm disturbance – Prophylactically – anticipation of conduction problem / failure
Bibliography • • CURRENT Diagnosis & Treatment: Emergency Medicine, 6 e, Ch 33. Accessed online: http: //www. accessmedicine. com. ezproxy. lib. ucalgary. ca Bessman Edward S, "Chapter 22. Invasive Monitoring, Pacing Techniques, and Automatic and Implantable Defibrillators" (Chapter). Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline
Questions? Joan Oliver and guide, Chris Hasler, on mountain climb, Lake Louise area, Alberta. c. 1936 Mount Le. Froy Mitre
- Slides: 21