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Hypoxia

“BRADY” DOWN FOR THE REST

History: A man in his 90’s presents to the ED for fatigue similar to what he had when he had a diverticular bleed a week and a half ago. He required 4 units of blood transfusion at that time. Patient denies any chest pain or shortness of breath but his pulse ox was noted to be low at 85%.

Exam: Vital signs are normal except   Exam is notable for clear lungs, hypoxia and symmetric bilateral pitting edema.

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):

3) Case Conclusion:  troponin-i was >0.01, D-dimer was high at 3.3.  CTPA shows a segmental PE and discoid ATX.  Leg duplex was negative.  No blood thinners were started due to recent severe GI bleed.

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. EKG is normal in 20% of EKGs.  This patient’s hypoxia may have actually just been due to atelectasis.  His baseline pulse ox was actually around 91%
  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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