History:
A patient in their early-40’s with no known medical history is transported from the streets to the ER after being found down without evidence of trauma next to a large empty bottle of vodka. No pill bottles were found. A shop owner called 911 when he found her lying in front of his business in the morning.
Exam:
HR 52, BP 115/73, RR 12 with sat of 94% on room air. Her exam is non-focal but she cannot cooperate with the exam so it has expected limitations
An ECG is done
Computer Read: SB with first degree AV block, moderated IVCD, ST elevation c/w injury, pericarditis or early repol, nonspecific ST and T wave changes
What should you do next?
- A) Order cardiology consult
- B) Order repeat the EKG in 15 minutes
- C) Order activated charcoal
- D) Order a Bair hugger
SCROLL DOWN FOR THE EKG ANALYSIS & 1-MINUTE CONSULT
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ECG ANALYSIS, QUIZ ANSWER, CASE OUTCOME/PEARLS & 1-MINUTE CONSULT:
My ECG interpretation (by Dr. D. Brady Pregerson of ERpocketbooks.com): there is severe bradycardia and a moderate first degree AV block. The P-waves look different so this could be some type of escape rhythm instead. There are Osborn J-waves but they fuse with the QRS in the inferior leads; they are best seen in V4-V6. Surprisingly there does not appear to be a-fib or shiver artifact, both of which are quite common in hypothermia this severe.
QUIZ ANSWER: What should you do next?
- A) Order cardiology consult
- B) Order repeat the EKG in 15 minutes – never a wrong answer but critical with ongoing angina that started in past 2 hours
- C) Order activated charcoal
- D) Order a Bair hugger – CORRECT – see below
Case Outcome: The standard thermometer could not measure a temperature; it just said “Low”. Eventually an indwelling Foley with a low-reading thermometer was placed and read 27.5 Celcius, which is 81.5 Fahrenheit. She was admitted to the ICU and did well
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