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EtOH & Abnormal EKG

UnFiNiShEd CaSe CoMe BaCk LaTeR

“BRADY” DOWN FOR THE REST

History: female in her 30s is brought in by medics for generalized abdominal pain vomiting and chest pain.  Pain is nonpleuritic and nonexertional.  She denies syncope, palpitations, chest pain, SOB, fever, cough or other complaints.

Exam: Vital signs are normal except   Exam is otherwise normal.

An EKG is done

PLACE SCREEN SHOT HERE

PLACE HIGH DPI IMAGE IN BRADY-CARDIA WORD DOC

What is the most likely primary diagnosis?

  • A) Hyperkalemia
  • B) Pulmonary Embolism
  • C) Acute Coronary Syndrome
  • D) Dysrhythmia

“BRADY” DOWN FOR THE EKG ANALYSIS & 1-MINUTE CONSULT

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QUIZ ANSWER< EKG ANALYSIS, CASE OUTCOME, 1-MINUTE CONSULT & CASE LESSONS: 

1) Quiz Answer: The answer is )

2) EKG analysis:   (check out more great EKG’s from Dr. Stephen W. Smith of Dr. Smith’s ECG Blog):  Initial EKG shows a sinus bradycardia at a rate of 57 with borderline QT interval of 474 ms. Repeat EKG shows a junctional rhythm with different P waves at a rate of 63 with QT interval measured at 466 ms. My interpretation is abnormal EKG but no definite evidence of ischemia

Cardiologist ectopic atrial

3) Case Conclusion:  troponin-i was <0.01  (99% URL <0.030: troponin-i immunoassay, Abbott laboratories) but K = 2.9, Mg = 1.3 and PO4 = 2.5

4) 1-Minute Consult from the Emergency Medicine 1-Minute Consult Pocketbook & Smartphone app on the topic for this case: See highlighted areas of sample page below.

PLACE PAGE HERE

5) Case Lessons: 

  1. Always
  2. Never

6) OMI Manifesto: If you haven’t yet read the OMI manifesto, you should.  It’s long but everyone should know at least the basics of why current STEMI criteria miss about 1/3 of occlusion MI’s that would benefit from emergent reperfusion and how you can pick up those patients and get them the care they need. CLICK HERE

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