okay, new thing i'm doing every week, i'll post the solution to the previous week's either when someone gets it right, or before i post the next one.

let's test your EKG skills and keep them sharp, b.

-----------------------------------
SCENARIO:

Dispatched to a sick call at the crazy indian people's annual Swimming Pool Party. En route, call is upgraded to resp. distress.

You arrive on scene, noting the crazy woman awkardly grunting and filming the entire thing, and are taken to find a 49 yo male positioned supine on the floor.

He looks like shit.

"I CAN'T BREATHE, I GOT DAT 190% CHEST PAIN" he screams.

"Okay, hold on there a second, buddy - let's see what we can do," you say.

Pt. is CAOx3, denies LOC, +nausea, -emesis, -JVD, no trauma hx, b/s c&e bilat, -accessory muscle usage, +"10"/10 c/p w/ rad. to back/neck/arm x2, pt. states pain is "worst in my life," onset ~30min earlier, -abd, MAEW, HEENT unremarkable, PERRL, -lateralization, skin cool/pale/diaphoretic. BP 130/78, P 48, RR 20.

Hx: dx w/ HTN ~2 wks ago

Rx: antihypertensive, denies viagra/ED meds

Allergies: NKDA

You do a 12 lead and see the following (very ugly and scary looking ):

-----------------------------------

so, tdub, what's wrong with this dude, and what would you do to intervene, if necessary? feel free to ask questions prn.

11/19/2007 6:59:37 AM

you better call a real doctor, because I think this thread was stillborn

11/19/2007 7:45:26 AM

haha

yeah that's cool youre an EMT and all

but nobody gives a fuck about all those details

11/19/2007 7:46:29 AM

I read this as EVAN'S WEEKLY KEG CHALLENGE

I was very disappointed.

11/19/2007 7:48:16 AM

o please i though this was gonna be challenging


he is having a massive NSTEMI with an AV block

he needs some MONA

and if his BP drops from the AV block he would need to be paced

11/19/2007 7:51:22 AM

just rub a lil tussin on him

11/19/2007 7:58:47 AM

Well, it's not lupus.

11/19/2007 8:03:47 AM

brainysmurf: WRONG (well, at least partially)

hint: look at the inferior leads. notice the st elevation.

11/19/2007 8:04:49 AM

Quote :

"I read this as EVAN'S WEEKLY KEG CHALLENGE I was very disappointed"

11/19/2007 8:10:25 AM

Quote :

"you better call a real doctor,"

fuck you legatic

11/19/2007 8:10:52 AM

Quote :

"haha yeah that's cool youre an EMT and all but nobody gives a fuck about all those details"

you missed the point of this thread entirely

11/19/2007 8:13:03 AM

This would be a fun challenge... if I knew *anything* about what

"Hx: dx w/ HTN ~2 wks ago Rx: antihypertensive, denies viagra/ED meds Allergies: NKDA"

meant

11/19/2007 8:15:07 AM

leads II, II and aVF show some definite ST elevation, suggesting an inferior infarct likely caused by a thrombotic occlusion of the RCA.

give O2, repeat ECG, get CK, MB and Troponin I, MONA

evaluate for cardiac cath and/or angiogram once stable

11/19/2007 8:15:27 AM

Quote :

""Hx: dx w/ HTN ~2 wks ago Rx: antihypertensive, denies viagra/ED meds Allergies: NKDA""

history: diagnosed with hypertension (high blood pressure) around 2 weeks ago
medications: some unknown antihypertensive med, denies taking viagra or any other erectile dysfunction meds (this is important)
allergies: no known drug allergies


i figured you'd not be able to understand the narrative

11/19/2007 8:18:09 AM

he's not on digoxin or anything is he? and do I see some tiny Q waves? has this guy had a history of angina? family history? drug use?

also, what are CAO and "b/s c&e"

[Edited on November 19, 2007 at 8:22 AM. Reason : ]

11/19/2007 8:18:44 AM

Quote :

"leads II, II and aVF show some definite ST elevation, suggesting an inferior infarct likely caused by a thrombotic occlusion of the RCA. give O2, repeat ECG, get CK, MB and Troponin I, MONA evaluate for cardiac cath and/or angiogram once stable"

ding ding ding, we have a winner! i expected nothing less from you

MY diagnosis:
our friend here has narrow-complex brady at 47/min. sounds like junctional escape rhythm to me. also have an IWMI aeb the ST elevation on the inferior leads and recip. depression in the high lats. st depression in v1/v2 most likely isn't anterior ischemia, my money is on a NSTEMI.

to verify: stick v4-v6 onto v7/v8/v9 and take a look.

may also be having an RVI due to the IWMI. do some right sided chest leads if you suspect it.

11/19/2007 8:22:12 AM

Quote :

"he's not on digoxin or anything is he? and do I see some tiny Q waves? has this guy had a history of angina? family history? drug use? also, what are CAO and "b/s c&e""

no digoxin, no hx of anything cardiac. no notable family hx or KDU.

and yes, those are some small ass q waves. that's the least of our worries right now, though

CAO = conscious alert and oriented, the x3 means to person/place/time

b/s c&e = breath sounds clear and equal, bilat = bilaterally

11/19/2007 8:23:53 AM

yeah that's about as far as we got in reading ECGs...recognizing st elevation and the basics of rate/rhythm/regularity/complex durations. hopefully next year I'll know what you're talking about

11/19/2007 8:24:55 AM

It would be a little more interesting if you'd spell out what the acronyms and jargon mean, otherwise it makes me just want to pic bomb and troll your thread you cunt rag.

11/19/2007 8:26:52 AM

shut up, read, and you might just learn something new

11/19/2007 8:28:19 AM

^^ douche

[Edited on November 19, 2007 at 8:33 AM. Reason : and you wonder why people on here dislike you... ]

11/19/2007 8:32:44 AM

i really like the idea of this thread, but without knowing half the jargon I'm dead in the water.

11/19/2007 8:33:57 AM

FTW

11/19/2007 8:40:51 AM

CAOx3 conscious alert oriented to name, time, place

denies LOC,(loss of consciousness) +nausea, -emesis(no puke) , -JVD,(jugular venous distention =his neck veins arent bulging) no trauma hx,(history) b/s c&e bilat(already explaned), -accessory muscle usage,(he isnt gasping for air and using all of his muscles to breathe) +"10"/10 c/p w/ rad.( chest pain with radiation) to back/neck/arm x2, pt.(patient) states pain is "worst in my life," onset ~30min earlier, -abd,(abdominal) MAEW,(moves all extremities well) HEENT(head, eyes,ears, nose, throat) unremarkable, PERRL,(pupils equal round reactive to light) -lateralization, skin cool/pale/diaphoretic.(sweaty) BP 130/78, P 48, RR 20.

11/19/2007 8:41:37 AM

Quote :

"brainysmurf All American 2929 Posts user info edit post shut up, read, and you might just learn something new 11/19/2007 8:28:19 AM TenaciousC All American 1126 Posts user info edit post ^^ douche [Edited on November 19, 2007 at 8:33 AM. Reason : and you wonder why people on here dislike you... ]"

You stupid fucking idiots. I say all the shit that everyone else is thinking, and you dickbags that can't get your mind unwrapped around the idea that I am better than you, give me these bullshit comments back...mindlessly...without even thinking about the shit you type...just as long as it is anti-Chance, thats all that matters.

Then, minutes after you two purge your idiocy on the thread, some other user validated my statement.

Fucking idiots. Stop trying to beat me, and listen to the shit I say.

11/19/2007 8:45:35 AM

everything else seems pretty self explanatory, but what besides portal hypertension would you be worried about if you saw significant JVD up to the angle of the mandible?

11/19/2007 8:46:59 AM

thx 2 brainysmurf for explaining the abbreviations to chance

if any of you plan on reading this thread (or plan on doing anything with medicine EVER, or just want to be an informed patient and be able to read your own chart), you may want to familiarize yourself with those acronyms. they are used in just about every assessment ever made.

i'll try in the future to explain any acronyms i use the first time i use them so you can follow along. sorry about that - it's just so much easier to write in shorthand like that.

11/19/2007 8:48:57 AM

also:

brady = bradycardia = slow heart beat
IWMI = interior wall myocardial infarction
NSTEMI = non ST elevation myocardial infarction
RVI = right ventricular infarction
myocardial infarction = heart attack

when we talk about ST elevation and Q waves and whatnot, here is what we're referring to:



any more questions, ask prn.

(prn = as needed )

11/19/2007 8:51:17 AM

everything else seems pretty self explanatory, but what besides portal hypertension would you be worried about if you saw significant JVD up to the angle of the mandible?



really shitty cardiac output from heart failure


very common with CHF patients

11/19/2007 8:58:13 AM

^x6

Benz240, that is hands down the weirdest text book I've ever read.

11/19/2007 8:58:23 AM

also

Quote :

"suggesting an inferior infarct likely caused by a thrombotic occlusion of the RCA."

basically: heart attack in the inferior wall of the heart caused by a blood clot blocking the right coronary artery

CK-MB = creatine kinase, high CK almost always means tissue is dying
troponin I = another cardiac biomarker, tells us if they're having an MI or not
MONA = morphine, oxygen, nitro, aspirin - the typical cocktail given to MI pts

11/19/2007 9:04:57 AM

Quote :

"I read this as EVAN'S WEEKLY KEG CHALLENGE I was very disappointed."

11/19/2007 9:19:06 AM

you fucking dyslexics.

11/19/2007 9:20:21 AM

tachycardia caused by excessive cocaine use

11/19/2007 10:33:03 AM

Student Health: He's pregnant.

11/19/2007 10:37:19 AM

^ student health at ecu: he's got and std and/or mono, send him home with some condoms and warn him not to let his friends drink behind him

11/19/2007 10:38:42 AM

^^aha

Quote :

"so, tdub, what's wrong with this dude, and what would you do to intervene, if necessary? feel free to ask questions prn."

What's wrong: his body ain't right
What to do: get his ass to a hospital

[Edited on November 19, 2007 at 10:39 AM. Reason : lkjd]

11/19/2007 10:39:28 AM

is the bookstore in Asheville, downtown called Malaprop's?

I've got a bet on this.......

11/19/2007 10:39:35 AM

10 years ago and I would have OWNED this thread.. I did see the ST elevation but it's been years since I looked at a 12 lead EKG :

11/19/2007 10:46:35 AM

poke him with a stick

11/19/2007 10:53:15 AM

Student Health: He's pregnant got the herp

11/19/2007 10:54:49 AM

Damnit evan, I'm a student not a doctor.

11/19/2007 11:37:01 AM

http://youtube.com/watch?v=GVxJJ2DBPiQ



http://youtube.com/watch?v=2nsN0vdXZuY&feature=related cardioverting a sedated guy with 190 bpm afib

[Edited on November 19, 2007 at 5:04 PM. Reason : .]


http://youtube.com/watch?v=STU7iNVxNuI&feature=related cardioversion with adenosine

[Edited on November 19, 2007 at 5:06 PM. Reason : .]

http://youtube.com/watch?v=EaAA3epTtvQ&feature=related defibrillating Ventricular Tachy

[Edited on November 19, 2007 at 5:09 PM. Reason : zap]

11/19/2007 5:00:44 PM

Man, I think I'm gonna have to have an EKG done tomorrow. I'm pretty frightened as to what's gonna pop up. My heartbeat is irregular at times...like the atria and ventricles fall out of sync or something. And it feels weird. It has me freaked the fuck out.

My dad was hospitalized last year about this time with atrial flutter. Cardioversion took care of his problem. Grandmother had the same issue about 35 years ago.

11/19/2007 5:30:59 PM

you've got a bum ticker?

11/19/2007 5:31:38 PM

I hope the hell not. Just an irregular heartbeat that I started noticing about a year, maybe a little longer ago.

It's like it skips a beat from time to time or beats extra hard every now and then, not totally in sync.

11/19/2007 5:33:58 PM

give him a spinal tap

11/19/2007 5:36:08 PM

that guy needs 50cc of cheese on his ham sandwich and stat(sp)

11/19/2007 5:47:07 PM

Evan are you just an EMT-B...even an I cert?

I only ask b/c being a B myself...I listen to my medic talk himself while he's doing the EKG, and its always interesting listening to him argue w/ himself.

Be doing my paramedic next fall

11/19/2007 5:57:15 PM

Quote :

"What's wrong: his body ain't right What to do: get his a** to a hospital"

Why this is my normal reaction, I find this thread quite interesting. It's got enough meat to keep me reading on wikipedia and such while I wait 2 hours for lightwave to HURRY THE FREAK UP.

Thx Evan

11/19/2007 6:33:45 PM