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SOB & Leg tight

UnFiNiShEd CaSe CoMe BaCk LaTeR

History: A woman in her 40’s with no PMH p/w SOB for 2 days that got worse today and right leg tightness.  No chest pain, fever, cough or other complaints

Exam: Vital signs are normal except for pulse of 120

An EKG is done

 

Computer Read: sinus tach at 116, LAE, IRBB, anterior t wave abnormality

 

What is the most likely cause of the EKG findings?

  • A) Hyperkalemia
  • B) Pulmonary embolism
  • C) Acute coronary syndrome
  • D) Hypocalcemia

“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:

 

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

3) Case Conclusion:  Troponin-i was 0.06  (99% URL <0.030: troponin-i immunoassay, Abbott laboratories).  Bedside echo showed dilated RA and RV with bowing of LV wall inwards.  CT showed submassive bilateral PE.

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. for more information CLICK HERE

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