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EKG Practice #4

Case

A 67 year old woman with metastatic squamous cell cancer presents to the emergency department having been found on the floor by a family member. She lived alone and cared for herself and was apparently given to heavily imbibing in solutions containing two carbon fragments. She was clearly quite ill, hypothermic, and confused. She was very weak and had difficulty moving her extremities. Her blood pressure was 95/55, and her temperature was 34 degrees centigrade. Her 12 lead ECG revealed this: ekg1

A closer look at leads V1 through V3 is found here:

ekg2

What is your interpretation, and what do you think that this patient’s electrolyte panel would show?

practice updates

EKG Practice #3

Ray Fowler, MD is Professor of EM / EMS at UTSW / Parkland. Edited by Alex Koyfman, MD.

Case #1

This 77 female presents with chest discomfort of several hours duration. She has a hx of stable angina, and she has not had any coronary intervention. On this evening, her discomfort worsened, and she called 911 and EMS responded.

En route you are contacted through BioTel that they would like for you to come and look at the transmitted ECG. They are worried that the patient may need cardioversion (see V1) or to at least go onto an antiarrhythmic drip. The following 12-lead is handed to you as you walk into the radio room. Look at V1. You have to make a decision NOW. Make your decision as to what to do.

ekgp3n1

Case #2

An 80 year-old male presents in acute distress with the worsening of chest tightness over the last few hours of the afternoon. He has had this before, he has stable angina, he has had a previous stent placed in the LAD, and he is compliant with his daily Plavix use. The ED is packed, the triage nurse has brought him back in a wheelchair, and he speaks only Burmese. What would you do?

ekgp3n2

practice updates

EKG Practice #2

Ray Fowler, MD is Professor of EM / EMS at UTSW / Parkland. Edited by Alex Koyfman, MD.

Case #1

A 38 year-old female presents about a month after having had epigastric and chest pain that was quite severe for an entire day about a month ago. She took some Zantac and Maalox, felt better, and went to bed. The next day she was weakened, but she gradually felt better and went about her business. In the last 24 hours she has noticed that she has had episodes of lightheadedness and occasional palpitations, so she comes to the ED. Your nurse hands you her ECG. What is your interpretation? ekg2-1

Case #2

A 36 year old male calls EMS due to chest pain and palpitations. Medics come and pick him up, and find him to be having severe chest pain with a systolic of 90. The medics call into BioTel (the online medical control) requesting instructions. They tell me that the man has a history of SVT. I asked them to transmit the ECG, and they sent this: ekg2-2 They are still on-scene, and their ETA will be about 10 minutes once en route. What would YOU do??

electrocardiography

EKG Practice

Ray Fowler, MD is Professor of EM / EMS at UTSW / Parkland. Edited by Alex Koyfman, MD.

45 male with intense epigastric pain radiating to his left arm with associated NV and diaphoresis. ekg1


55 female with crushing anterior chest pain and diaphoresis. ekg2
ekg3
A sinus tachycardia is present in this 54 year old man with severe chest pain radiating to the left arm.

ekg4


This is a narrow complex tachycardia in a 31 year-old female that is perfectly clock regular. There is no obvious atrial activity seen. The QRS is narrow. ekg5
This 65 year-old woman presents with lightheadedness and worsening dyspnea on exertion. ekg6
This 81 year old man had a syncopal episode. He presents a little confused, GCS 14 (lies with his eyes closed), and is “not right” per his wife. His BP is 110/76, and he has the cardiogram below. ekg7
ekg8
This is an odd 12 lead ECG to have done in this 54 year old man. The rate is profoundly slow, in the 20’s or so. The rhythm is regular. There is no evident atrial activity. The QRS is very widened. ekg9