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History: A 72-year-old male with a history of bradycardia and TIA is transported from SNF for altered mental status.  He looks at you but cannot give any history

Exam: Vital signs are normal except for a pulse of 40 and a temperature of 85.  He is altered.  On the monitor he appears to be in atrial fibrillation with rates between 32 and 60.  BP is 122/66

Initial differential diagnosis: stroke, medications toxicity, myxeda,

  • Labs: platelets 22K
  • EKG: sinus brady at 40 with Osborne wave
  • Imaging: see below

QUESTIONS:

  1. What does the case image show?  A layering intraventricular bleed
  2. What should you do next?  Consult neurosurgery, consider platelet transfusion
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The image shows .
  2. What should you do next?  Treat with.  Consult.
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

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CASE CONCLUSION: We’ll just have to see

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