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em photo quiz( occasional series)


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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

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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.

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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?

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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.....

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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!

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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

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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).

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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.

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