GetMeOuttaThisMess Posted January 10, 2019 Share Posted January 10, 2019 ER. Okie dokie. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 10, 2019 Author Moderator Share Posted January 10, 2019 10 minutes ago, GetMeOuttaThisMess said: Okie dokie. I own and use a set of calipers....but then again, I used to use an ekg machine with a single suction cup that one had to move to get each lead. Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted January 10, 2019 Share Posted January 10, 2019 18 minutes ago, EMEDPA said: I own and use a set of calipers....but then again, I used to use an ekg machine with a single suction cup that one had to move to get each lead. Moved from room to room by a donkey. I think I’ve still got some calipers lying around. Wonder if anyone thinks anything of the deep Q waves right precordial leads (or so they appear) and the IVCD? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted January 10, 2019 Author Moderator Share Posted January 10, 2019 first trop negative an unk time after syncope(pt found on floor after unk down time). 2nd trop not done as pt transferred emergently for pacer. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 24, 2020 Author Moderator Share Posted October 24, 2020 Eye pain. Va 20/200. Thoughts? Quote Link to comment Share on other sites More sharing options...
MediMike Posted October 24, 2020 Share Posted October 24, 2020 1 hour ago, EMEDPA said: Eye pain. Va 20/200. Thoughts? Looks kind of like a close up picture of one 'o those hairless cats? Was this a spontaneous presentation? Trauma? Misshapen pupil would concern me for a globe injury, the sclera looks burnt unless it's just gnarly red. The white discoloration reflection or actual color change? I'm going to need you to take another picture sir. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 24, 2020 Author Moderator Share Posted October 24, 2020 pt already gone after ophtho consult. spontaneous onset of pain, redness, and light sensitivity with decreased VA. no fb sensation. clear d/c. no trauma. sclera is very injected. The white is reflection, not chemosis. agree about the teardrop pupil. ddx of same? 1 Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted October 24, 2020 Moderator Share Posted October 24, 2020 Looks like a tear drop pupil concerning for globe rupture, but without our history of trauma more concerning for uveitis. Definitely lots of history questions about when it started, light exposures, welding, grinding, joint pain, fever, trouble urinating, back pain, sexual history could be ankylosing, reiter’s, photokeratitis, corneal ulceration with spontaneous rupture in contact use? Not exhaustive list, but my first thoughts @EMEDPA 1 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 24, 2020 Author Moderator Share Posted October 24, 2020 retired 80 yr old guy. driving across country in his RV. never seen before in our system. poor historian. no specific sx involving any other system. no trauma. no contact lens use. I had the same concerns as you folks. The key to this was something I got from the pts ophtho from out of town via phone consult. Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted October 24, 2020 Moderator Share Posted October 24, 2020 10 minutes ago, EMEDPA said: retired 80 yr old guy. driving across country in his RV. never seen before in our system. poor historian. no specific sx involving any other system. no trauma. no contact lens use. I had the same concerns as you folks. The key to this was something I got from the pts ophtho from out of town via phone consult. Cheating and got out my will’s eye manual. Neovascularization? Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted October 25, 2020 Share Posted October 25, 2020 (edited) Pupil an incidental finding from prior surgery (cataract). R/O retinal vein occlusion. Edited October 25, 2020 by GetMeOuttaThisMess Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted October 25, 2020 Author Moderator Share Posted October 25, 2020 3 hours ago, GetMeOuttaThisMess said: Pupil an incidental finding from prior surgery (cataract). Bingo! pt could have mentioned that, don't you think....yup, iritis with postsurgical change that I almost lost my $hit about rx pred forte drops QID and Timolol drops BID. 1 Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted October 25, 2020 Moderator Share Posted October 25, 2020 1 hour ago, EMEDPA said: Bingo! pt could have mentioned that, don't you think....yup, iritis with postsurgical change that I almost lost my $hit about rx pred forte drops QID and Timolol drops BID. Ah, yes. Should’ve thought of that. The post surgical tear drop. Seen this a bunch of times and usually catch it by the weird flashy reflection, like liquid in a well that you see shake when they move their eye. also it would be nice if a patient could give a relevant history It’s really surprising though the number of people who have no idea if their pupil in normally misshapen. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 25, 2020 Author Moderator Share Posted November 25, 2020 Thoughts? Quote Link to comment Share on other sites More sharing options...
MediMike Posted November 25, 2020 Share Posted November 25, 2020 46 minutes ago, EMEDPA said: Thoughts? I'm either: A) Too lazy B) Too technologically inept to download the photo and rotate it, but just glancing appears to be a sinus bradycardia at a rate of ~55. Normal axis, normal R wave progression. Inferior leads look a little funky but no significant STE/STD, a bit of a conduction delay leading to a Rsr pattern in II and that slurry downstroke in aVF. Clinical vignette? Would be worth doing serials to look for any evolution, the inferior leads are just weird enough that I'd be comfortable repeating it. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 25, 2020 Author Moderator Share Posted November 25, 2020 Exertional cp resolved with rest only in 80 yr old w hx of angina and no prior cath Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 26, 2020 Author Moderator Share Posted November 26, 2020 Three cardiologists called it a stemi in evolution. Clean cath. Quote Link to comment Share on other sites More sharing options...
MediMike Posted November 26, 2020 Share Posted November 26, 2020 2 hours ago, EMEDPA said: Three cardiologists called it a stemi in evolution. Clean cath. Interesting. They took an exertional CP guy who was CP free to the lab emergently? You've got a different breed of cardiologists in your neck of the woods my friend. And THREE? I had a gal arrest multiple times with obvious STE on ROSC which gradually went away on serial leads, had to die like 3 times before they'd take her. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 26, 2020 Author Moderator Share Posted November 26, 2020 22 minutes ago, MediMike said: Interesting. They took an exertional CP guy who was CP free to the lab emergently? You've got a different breed of cardiologists in your neck of the woods my friend. And THREE? I had a gal arrest multiple times with obvious STE on ROSC which gradually went away on serial leads, had to die like 3 times before they'd take her. yup. great story. prior angina hx. was walking out to car with onset of "vice like" chest pressure and significant drenching diaphoresis. they wanted me to fly her, but no helicopter available so she went 2 hrs code 3 by ground to the nearest cath lab. They have fellows, so they cath everyone. and your pt: WTF. Quote Link to comment Share on other sites More sharing options...
MediMike Posted November 26, 2020 Share Posted November 26, 2020 6 minutes ago, EMEDPA said: yup. great story. prior angina hx. was walking out to car with onset of "vice like" chest pressure and significant drenching diaphoresis. they wanted me to fly her, but no helicopter available so she went 2 hrs code 3 by ground to the nearest cath lab. They have fellows, so they cath everyone. and your pt: WTF. Well ya know, WA has public reporting of cath lab outcomes so they are fairly loathe to take anyone who may die. That is the nice thing about academics, it was never easier to get a cath than when I worked at the University. Or a balloon. That's a long bumpy ride man! Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted November 26, 2020 Share Posted November 26, 2020 Were they considering the T waves in II, III, and aVF hyperacute? I'm old and somewhat low tech. I printed out your EKG and rotated it. 1 Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted November 26, 2020 Share Posted November 26, 2020 (edited) 14 hours ago, EMEDPA said: Three cardiologists called it a stemi in evolution. Clean cath. Prinzmetal’s. Saw it up close and personal in the cath lab on a patient. On ETT in office he tried to sail out of the office still attached to the machine due to the wind sails that he developed. Rolled him over to the hospital telemetry floor, did his H&P, went with him to cath lab that afternoon, and clean as a whistle...until he got the the joy juice and then he started screaming bloody murder that his pain was present. CCB time. BTW, what happened to the head CT discussion? What was the answer? Edited November 26, 2020 by GetMeOuttaThisMess Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 26, 2020 Author Moderator Share Posted November 26, 2020 15 hours ago, ohiovolffemtp said: Were they considering the T waves in II, III, and aVF hyperacute? I'm old and somewhat low tech. I printed out your EKG and rotated it. they were focused on the ST elevation and flipped T in AVL Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted November 26, 2020 Moderator Share Posted November 26, 2020 17 hours ago, MediMike said: I had a gal arrest multiple times with obvious STE on ROSC which gradually went away on serial leads, had to die like 3 times before they'd take her. I’m not sure if I’m happy or sad that it’s not just my cardiologists that are like this, but it actually is the cardiology fellows that are like this. Even the IM attendings think it the most toxic cards fellowship and complain about it. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 27, 2020 Author Moderator Share Posted November 27, 2020 9 hours ago, LT_Oneal_PAC said: I’m not sure if I’m happy or sad that it’s not just my cardiologists that are like this, but it actually is the cardiology fellows that are like this. Even the IM attendings think it the most toxic cards fellowship and complain about it. We have just the opposite problem. They cath everyone. The first cardiologist I called about this was wondering why I called because they felt it was an "obvious inferior stemi in evolution", while myself and the ED attending thought great story, worrisome, but not slam dunk EKG. At least they didn't want to give her TPA before we shipped her. I felt that might have been over the top given no pain and nl trop #1 and no change in ecg at 30 min post #1. yes, she got heparin and plavix. I was on board for that. 2 Quote Link to comment Share on other sites More sharing options...
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