2

11/19/2007 6:49:28 PM

it's an acute transmural anterior MI. And that's how you'd treat it!!

Patients with transmural (with ST segment elevation) myocardial
infarction should immediately be considered for reperfusion therapy.
Fibrinolytic therapy with streptokinase, alteplase, or reteplase
should be started within 30 minutes of presentation for patients
without bleeding risk. Alternatively, patients at tertiary care
hospitals can undergo emergency coronary angioplasty. Other lifesaving
pharmacologic interventions include administering aspirin,
beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors.
Oxygen, morphine sulfate, heparin, and nitroglycerin are also useful.
No benefit has been demonstrated for calcium channel blockers,
magnesium, or prophylactic lidocaine. Patients need to be closely
monitored for conduction abnormalities, arrhythmias, and heart
failure.

[Edited on November 23, 2007 at 6:48 PM. Reason : .]

11/23/2007 6:48:36 PM

I dont care what anyone says, this thread isnt stupid.

Ill never do anything with medicine, but I love learning anything, even if i will never apply it.

Keep em coming.

11/23/2007 6:59:50 PM

I have a recent EKG you could analyze, unfortunately my heart is in perfect health.

11/23/2007 7:17:58 PM

Quote :

"unfortunately my heart is in perfect health"

11/23/2007 7:18:29 PM

wish i had a copy of a rhythm strip from a post-code pt admitted to the unit the other night. It was the FUGLIEST rhythm ever.

the Vtach alarm kept going off all night, but none of us noticed ANYTHING different about the rhythm on the screen.

11/23/2007 7:27:34 PM

bttt

11/26/2007 9:57:12 PM

oh shit i forgot about this

i'll post one tomorrow for you people

11/26/2007 10:04:11 PM

what does it mean if the T wave is 2/3 the height of the QRS?

11/26/2007 10:05:30 PM

Quote :

"what does it mean if the T wave is 2/3 the height of the QRS?"

hyperkalemia, early MI...perhaps

11/26/2007 10:12:13 PM

I would like to request a monthly dumbed down version, so us physiology grad students can play

11/26/2007 10:13:27 PM

ok i have no history or background info on this patient
other than she is admitted for some sort of cerebral injury.

i just walked by the monitor and said EWWW!!

this one isnt hard at all

11/26/2007 10:19:26 PM

give her a spinal tap and push thrombolitics

11/26/2007 10:20:46 PM

more like the Respiratory toolbox, and ventilator are set up and ready to go for when she crumps

11/26/2007 10:22:06 PM

i said give her a spinal tap and push thrombolytics

11/26/2007 10:23:49 PM

Quote :

"what besides portal hypertension would you be worried about if you saw significant JVD up to the angle of the mandible?"

heart failure, tamponade, cardiomyopathy, pericarditis...

11/26/2007 10:24:07 PM

you big-shot hollywood doctors gonna crack his chest open and be the hero, eh?

now look here: the boy just gone and swallowed some of his daddy's chaw.

give him a Coke Cola and he'll be fine in 30 minutes.

11/26/2007 10:27:25 PM

Quote :

"ok i have no history or background info on this patient other than she is admitted for some sort of cerebral injury. i just walked by the monitor and said EWWW!! this one isnt hard at all "

i'm not sure what to diagnose, but it looks like some pretty strong ST segment elevation in all leads (is the ST supposed to be inverted in AVR?) and really tall QRS complexes...

i have no fucking idea other than yet another STEMI...but since it's across all leads she might be acutely hypotensive (HR is kinda low too)

[Edited on November 26, 2007 at 10:44 PM. Reason : ]

11/26/2007 10:39:45 PM

ill have to find out from the nurse tomorrow what she is in for

11/26/2007 10:41:42 PM

i stand by my original treatment

11/26/2007 11:51:05 PM

pericarditis for the last one

11/27/2007 10:23:13 AM

btttachycardia

11/29/2007 12:25:38 AM

wtf bro, trying to keep my skillz sharp over here

you can just post some interesting cases (presenting S&S, vitals, brief hx, meds) and we try to figure out the diagnosis house style

but keep it clean, b (don't want any HIPAA trouble)

[Edited on November 29, 2007 at 5:23 PM. Reason : ]

11/29/2007 5:23:24 PM

12/19/2007 4:30:24 PM

i keep forgetting about this thread

wait until i get home from work and i'll see what i can dig up

12/19/2007 4:31:46 PM

that pic sucks i can't read it.

12/19/2007 4:34:43 PM

Uh

Put the dude on a treadmill and see if he takes off

12/19/2007 4:44:15 PM

i have one with a small case study

but no more room in my photo gallery

12/19/2007 4:55:40 PM

you guys got any renal cases?

12/19/2007 7:26:00 PM

what does a

Quote :

"pretty strong ST segment elevation"

indicate?

[Edited on December 19, 2007 at 7:43 PM. Reason : ]

12/19/2007 7:43:05 PM

^ impending MI

12/19/2007 8:24:14 PM

okay, writing up another one

hold on

2/9/2008 5:32:23 PM

dispatched to a medical unknown.

UOA we find a 62 y/o male laying supine in his bed. his mother (who is 88 y/o) states that he was "in some sort of horrible pain." pt. c/o indigestion from po intake x2 hours. pt. is caox3, denies LOC, - PERRL, - JVD, - HEENT, denies emesis re indigestion. first responders on scene report BP 70/50, RR 18/irregular, - radial pulse. pt. says pain is a "6"/10 and localizes pain to sternum slightly proximal to zyphoid process, "i think i might just have gas." pt. denies dyspnea, BS c/e bilat, mild cyanosis of lips, - abd, MAEW, skin is cool/pale/diaphoretic.

NKDA, hx of HTN

rx: glucophage 850mg po bid, lopressor 100mg po bid



being the good wake county ALS technician that you are, you remembered to bring the monitor in with you... right? ...RIGHT?

you ask your partner, Amy Winehouse, to go get the bed and spike a line in the truck.

in the meantime, you obtain a 12 lead and see the following:






what's wrong with this dude (besides the fact that he's 62 and still living with his mom), how would you fix it, and how do you know?

feel free to ask any questions if something's unclear.

2/9/2008 5:48:37 PM

IN CASE YOU DIDN'T GET THE NOTICE MR. KINNEY, YOU ARE NO LONGER A MEMBER OF ANY EMS.

[Edited on February 9, 2008 at 5:51 PM. Reason : LOL DON'T KNOW WHAT I WAS THINKING SPELLING IT LIKE THAT, I KNEW THAT, SORRY]

2/9/2008 5:50:15 PM

*kinney

and

2/9/2008 5:51:01 PM

goddamn


how is he still concsious


how is he getting any perfusion?


well, i have heard of a few people just walking around the CCU floor on telemetry in vtach


shit, i dont even know what to call this

very wide complex arrythmia for sure


um, lidocaine amiodarone perhaps


hmm lemme get the acls book out

kk maybe shock his ass

ehe ACLS says to seek expert consultation

[Edited on February 9, 2008 at 10:39 PM. Reason : i dunno, we'd be like OMFGWTFBBQ on our floor paging the HO!]

2/9/2008 10:34:31 PM

lmfao

you're right in the dx

wide complex vtach




guess again on the treatment

it's something simple.

[Edited on February 9, 2008 at 11:03 PM. Reason : hah, never mind, you got that too... now... HOW would you shock him?]

2/9/2008 11:02:56 PM

p.s.

Quote :

"you can just post some interesting cases (presenting S&S, vitals, brief hx, meds) and we try to figure out the diagnosis house style but keep it clean, b (don't want any HIPAA trouble)"

i think i'll just start doing this

it's hard to find good 12 lead strips

2/9/2008 11:07:23 PM

id put the stickers on him and get the epi ready in case he does code

but if he doesnt convert with the amiodarone


i dont know that the lifepak would sync up for a cardioversion


he is relatively stable at this point and has a pulse and a BP no need to defibrillate him........yet

but the minute he crashed.............charge to 200J and zap his ass

2/10/2008 12:41:54 AM

cardioversion is the acceptable answer

the lifepak 12's can actually do it, even with a shitty strip like that

2/10/2008 1:25:58 AM

newbie, I'm paging Dr. Cox.

2/10/2008 7:11:42 AM

damn, got here too late. new case plz?

2/10/2008 3:15:55 PM

goddamn you people are demanding

lemme finish cleaning my house

then i shall write a new one

no 12 lead this time, but i'll make it interesting

2/10/2008 3:59:48 PM

Just now stumbled across the thread, we recently went over EKG analysis so this thread will be good practice. As a matter of fact any cases anybody wants to throw in here would be awesome (not necessarily EKG). I could throw in some cases from my Clinical Learning, but they're too easy most of the time

Keep em comin

2/10/2008 4:03:02 PM

^you in med school?

2/10/2008 4:06:11 PM

MS1 at WVU

2/10/2008 4:08:39 PM

awesome.

welcome to the greatest thread ever on tww.

of course... me, brainysmurf, benz240, and DaveOT are the only ones that actually post in here.. but oh well, haha

2/10/2008 4:10:28 PM

OK here's one in the meantime:

A 19-year-old male college student presents to the student health department with abdominal pain, diarrhea, and fever. He says that his symptoms started one day ago. He has had 10 stools in the past day and has noted blood mixed in with the stool on several occasions. He usually eats at home but reports having eaten chicken in the college cafeteria three days ago. He has no history of gastrointestinal (GI) disease. On examination he has a temperature of 37.8°C (100°F) and appears to be in pain. His abdomen has hyperactive bowel sounds and is diffusely tender but without rigidity, rebound tenderness, or guarding. A general surgeon is consulted and is considering the diagnosis of acute appendicitis versus bacterial gastroenteritis possibly related to the chicken eaten. A stool sample tests positive for blood and fecal leukocytes. Stool cultures are sent and are subsequently positive for a pathologic organism.

What is the most likely pathologic organism?

2/10/2008 5:53:05 PM

tapeworm?

2/10/2008 5:55:14 PM

my first guess would be salmonella

2/10/2008 5:56:52 PM