Case 3 – ECG

IMG_2556

Thanks Aaron for sending in this ECG.

Hx: 53 yom became stiff at the height of intercourse, had seizure like activity, then unresponsive (exact words from the ePRF).

Diaphoresis +++, covered in vomit, urinary incontinent.
GCS 11 (3, 3, 5), HR 60, RR 18, BP 70/50, BGL 7.7, Temp 37.2, Pupils 2mm reactive x 2

 

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2 Comments Add yours

  1. Tatsu Kuwasaki says:

    I did intentionally choose this ECG following another case with global ST depression with ST elevation on aVR a couple of months back. https://chchparamedics.wordpress.com/2018/09/06/stemi-equivalent/
    This is done so to highlight the other potential causes rather than the proximal LMCA occlusion.
    Always look at the patient (not the numbers on the monitor or ECG alone).

    Like

  2. Tatsu Kuwasaki says:

    ICP Aaron who sent in the ECG commented as below.

    “Hi all,

    The patient had a dissecting thoracic aneurysm which on the scan was shown to extend from the belly button up the aorta, over the aortic arch and was starting to descend down the LAD. The patient had a 2% chance of survival given the presentation.

    The case was an interesting one due to the severe agitation associated with the presentation. There was some discussion around the preentation looking cerebral (given the potential for such a presentation during intercourse), however cerebral patients have never presented with severe diaphoresis (in my experience). So we had an issue between a CVA presentation and a cardiac presentation.

    Concern was then given as to the type of sedation to use. Midaz would be neuro protective but with his current BP that was not possible. Ketamine could support the BP but risked cardiac demand as well as an ICP spike which would be less than desirable in a CVA patient. Ended up opting for 100mcg fast push of fentanyl with a second dose being the next option.

    Interesting presentation. The patient was in ICU for 10 minutes before arresting.

    Cheers,

    Aaron T”

    Like

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