ChrisPAinED Posted May 25, 2022 Share Posted May 25, 2022 On this thread please give a short description on a interesting presenting patient. I will give a example. Going to be unspecific and not share details that aren't important for patient privacy. A female in her 30s came in with dizziness Triage note: HR 130s BP 94/51 O2 97% RR 16 BGL 100 temp 98.7f (patient is also 8wks pregnant) Pmx of a MI at age 23! Social history informs us she doesn't smoke, drink, but she is recovering from a cocaine and oxycodone addiction. She quit all the drugs once she found out she was pregnant and had around 3wks of moderate withdrawal symptoms. The cocaine was expected to caused the MI. It was a type 2 myocardial infarction. CBC, BMP, CRP, D-dimer, and a troponin All normal but the troponin which was 1.02 when norm range was 0.00-0.04. On exam patient had clear breath sounds but had a fast irregular heart beat. ECG showed AFib with RVR and some ST depression. I immediately got my supervising physician and informed him of the issue. Called on call cardiology and obstetrics. Patient was taken to PCI and while in cath lab cardiology called wanted us to sign for a CCU admission from ED. So we signed off and then not updates after that. I am going to guess she was okay because we have a really good cardiac team. Quote Link to comment Share on other sites More sharing options...
ChrisPAinED Posted May 25, 2022 Author Share Posted May 25, 2022 D dimer was also slightly elevated but don't remember the value because this wasn't a recent case. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 25, 2022 Moderator Share Posted May 25, 2022 1 hour ago, ChrisPAinED said: D dimer was also slightly elevated but don't remember the value because this wasn't a recent case. dimers are often elevated in pregnancy up to 2x high normals. 1 Quote Link to comment Share on other sites More sharing options...
ChrisPAinED Posted May 25, 2022 Author Share Posted May 25, 2022 5 minutes ago, EMEDPA said: dimers are often elevated in pregnancy up to 2x high normals. Yep which is why it was relevant to this case! Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted May 25, 2022 Moderator Share Posted May 25, 2022 42 minutes ago, ChrisPAinED said: Yep which is why it was relevant to this case! try and get us some follow up. was she cardioverted, rate controlled with meds, anticoagulated, etc. Good case. 1 1 Quote Link to comment Share on other sites More sharing options...
ChrisPAinED Posted May 25, 2022 Author Share Posted May 25, 2022 2 minutes ago, EMEDPA said: try and get us some follow up. was she cardioverted, rate controlled with meds, anticoagulated, etc. Good case. I will ask the cardiologist if he remembers what happened tonight! Quote Link to comment Share on other sites More sharing options...
ChrisPAinED Posted May 26, 2022 Author Share Posted May 26, 2022 2 hours ago, EMEDPA said: try and get us some follow up. was she cardioverted, rate controlled with meds, anticoagulated, etc. Good case. She got a synchronized cardioversion and a heparin drip. 1 Quote Link to comment Share on other sites More sharing options...
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