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Flank Pain + SOB

UnFiNiShEd CaSe CoMe BaCk LaTeR

History: A woman in her 40’s comes to the ER with vomiting, R flank pain and SOB like prior episodes of pyelo.  She denies syncope, palpitations, SOB, fever, cough or other complaints.

Exam: Vital signs are normal except for BP 187/100

An EKG is done

Computer Read: Sinus bradycardia at 53, possible LVH, anterior MI, probably recent

 

What is the most likely cause of the EKG findings in this patient?

  • A) Hypokalemia
  • B) Medication toxicity
  • C) Acute coronary syndrome
  • D) Hyperventilation

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

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

Quiz Answer:

  • A) Hypokalemia
  • B) Medication toxicity
  • C) Acute coronary syndrome
  • D) Hyperventilation

EKG analysis (check out more great EKG’s from Dr. Stephen W. Smith of Dr. Smith’s ECG Blog):

Case Outcome:  Troponin-i was <0.03  (99% URL <0.030: troponin-i immunoassay, Abbott laboratories).  Mg = 1.5, K = 2.7

1-Minute Consult from EM1minuteConsult.com on the topic for this case

CLICK HERE AND SCROLL TO TOP OF PAGE 287

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Case Lessons: Common causes are diuretics, diarrhea and drinking (the 3 D’s).  If K is particularly low check Mg as well as you need to replete both to fix the situation.

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