Main menu:

Google


Torso Pain & EtOH

UnFiNiShEd CaSe CoMe BaCk LaTeR

History: A man in his late 20’s with a history of pancreatitis from alcohol presents to the ED for epigastric and chest pain.    He denies syncope, palpitations, SOB, fever, cough or other complaints.

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

An EKG is done

What is the most likely diagnosis?

  • A) Myocarditis
  • B) Pulmonary Embolism
  • C) Acute Coronary Syndrome
  • D) Pancreatitis

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

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

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

THE EMERGENCY MEDICINE POCKETBOOK TRIFECTA

Tarascan Emergency Department Quick Reference Guide     

                             

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

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

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

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

1) Quiz Answer: The answer is A) Myocarditis due to his age, but as this is a diagnosis of exclusion this should be treated as a STEMI until proven otherwise

2) EKG/Echo analysis (check out more great EKG’s from Dr. Stephen W. Smith of Dr. Smith’s ECG Blog): There is obvious ST elevation in the inferior leads (2-3-aVF) with reciprocal ST depression in lead aVL.  This is concerning for a STEMI.  Other considerations include myocarditis, pericarditis, etc.

3) Case Conclusion:  troponin-i peaked at 64 (99% URL <0.030: troponin-i immunoassay, Abbott laboratories).  Patient went to the cath lab and was found to have clean coronaries.  His EKG changes were presumed to be due to myocarditis.

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

:
Google
 
Web www.edinsight.com