ECG1: Found Down

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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