Jump to content

em photo quiz( occasional series)


Recommended Posts

  • Replies 267
  • Created
  • Last Reply

Top Posters In This Topic

Top Posters In This Topic

Popular Posts

Many the time I've seen the fellows throw dopamine onto a non-hypotensive patient with rates that they "just aren't comfortable with" with a resultant BP in the 180s+. Dobutamine is a fantastic +

It will be fascinating, while tragic, some day to know exactly why the diverse outcomes of this strange disease. It is beyond comorbidities, while they contribute.

What we are seeing is this: Asymptomatic screen + from large workplace screenings. sent home to quarantine one week later looks like death warmed over and crashing. generally arrives by priv

Posted Images

For some reason, the thumbnails aren't enlarging when I click on them, but it looks like some ST seg. elevation in the septal leads....so I'm guessing septal infarct....nice to see the rest to look for any reciprocal changes....the xray is much harder to read being so small...looks like a FB is all I can say

Link to post
Share on other sites
  • Moderator
For some reason, the thumbnails aren't enlarging when I click on them, but it looks like some ST seg. elevation in the septal leads....so I'm guessing septal infarct....nice to see the rest to look for any reciprocal changes....the xray is much harder to read being so small...looks like a FB is all I can say

 

not a fb...

you don't need to see the whole ekg for this dx only leads v1 and v2.

Link to post
Share on other sites

On the EKG, I see flipped T waves in V1 and V2. I'm also not sure if I'm seeing P waves at all, which is especially weird considering the rate around 100. The QRS could also be a little tight. As to what causes that... well, I'm a new grad. I have some street smarts but need practice to see the forest for all these trees.

 

Of course, we know nothing about history, presentation, or exam (but what would be the fun in that, right?)

 

The xray is gnarly. I can't figure out what is being avulsed here, as that radio-opaque lump is a fair distance from anywhere that might be normal anatomic position (for a chunk of distal radius, say, and that goes double for a carpal bone). Maybe a calcification where there had been an old injury?

Link to post
Share on other sites
  • Moderator

see this link for info on the ekg finding:

http://en.wikipedia.org/wiki/Brugada_syndrome

 

this particular ekg goes along with a woman who had chest pain followed by syncope. she ended up with an AICD.

 

that "radio-opaque lump" is one of the carpal bones-the lunate in fact. worst dislocation any of us had every seen. elderly guy fell forward striking his palmar surface and volar wrist on the ground. yes, it required a surgical repair.....

Link to post
Share on other sites

I feel pretty good about this....Only first month of school down and I got the xray almost immediately although what has been said of it is correct. That is one wayyyyyyy displaced lunate.

Now the EKG is another story. That will be for next semester. :D

 

Thanks for the quizzes-they make us think!

Link to post
Share on other sites
  • 5 weeks later...
  • 4 months later...
  • 2 months later...

That is certainly very atipical. Generally people do not make it out of the second decade of life without an AICD. Something to keep in mind is that this condition has a very strong family tie! This condition is what causes a large portion of sudden cardiac arrest in young athletes.

 

Tim

Link to post
Share on other sites
  • 2 years later...
  • Moderator
auto converted or was there some chemical assistance?

she was on the treadmill, stage 1 of a bruce protocol, said " I feel dizzy" concurrent with her 18 sec run of vtach. I stopped the test(duh) sat her down, put her on o2, reached for the amio and she converted back to nsr. I called cards and she was in the cath lab 30 min later and ended up with 2 stents if memory serves(this was a few yrs ago, I just found the ekg in my desk).

  • Upvote 1
Link to post
Share on other sites

same patient? Second degree type I? I want to point a finger at injury in the anterior/inferior aspect due to the flipped T's but my ECG memory starts to get fuzzy in that department. I notice an absence of pathological q wave in aVF. Is the pronounced Q not a specific sign of an old MI?

Link to post
Share on other sites
  • Moderator

different patient...and yes wenkebach( 2nd degree type 1) due to beta blocker o.d.

there is a single isolated Q in III and widespread T wave inversion but this patient did not have chest pain, hx of MI or + enzymes. when she was in nsr again all of this resolved so was probably rate related. her chief complaint(for which she sat in the waiting room for 45 min unmonitored...) was "weakness" despite a reasonable bp.

Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.


×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More