Main menu:

Google


Syncope & Bradycardia*3

“BRADY” DOWN FOR THE REST

History:

A 22-year-old male with no PMH is brought to the ED for syncope.  He was getting a haircut when he fainted.  Medics say on arrival his BP was in the 60’s and the HR was in the low 30’s.  The patient states that he has fainted a bunch of times in the past but never saw a doctor for it.  He denies palpitations, chest pain, SOB, fever, cough or other complaints.

Exam:

Vital signs are normal except for a pulse of 48.   Exam is otherwise normal.

Initial differential diagnosis:

  • Bradydysrhythmia
  • Vasovagal episode
  • Panic attack
  • Hypothyroidism
  • ACS

Initial EKG (click TWICE if you want to enlarge):

COMPUTER EKG READ:

  1. Sinus Bradycardia
  2. Borderline ECG

Do you agree with the computer?

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

<<<<<<<<<<<<<<<<<<<<< ADVERTISEMENT & SPACER >>>>>>>>>>>>>>>>>>>>>

***************************************************************************

THE EMERGENCY MEDICINE POCKETBOOK BIFECTA

Tarascan Emergency Department Quick Reference Guide

Get one of our publications, all designed specifically for Emergency Care Providers:

***************************************************************************

<<<<<<<<<<<<<<<<<<<<<<<<< END SPACER >>>>>>>>>>>>>>>>>>>>>>>>>

EKG ANALYSIS, CASE CONCLUSION & 1-MINUTE CONSULT: 

  • EKG Analysis: The computer read is correct.  For syncope always focus on the intervals (long QT and short PR) in addition to looking for tachycardia, bradycardia and ischemia.
  • Case Conclusion: labs and orthostatics were normal.  The patient stated he wouldn’t have come to the ED if this had happened at home.  On further probing questions you determine that the syncope occurred while the barber was shaving his neck.  Carotid sinus hypersensitivity is diagnosed.  The baseline bradycardia probably puts him at higher risk of this.
  • 1-minute Consult: See highlighted area of sample page below and Case Lessons below that.

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

Source: The Emergency Medicine 1-Minute Consult Pocketbook   

Case Lessons

  1. Asking probing questions may help make the diagnosis
:
Google
 
Web www.edinsight.com