A 60-year-old man presents with chest pain. His EKG shows ST elevations in leads II, III and aVF as well as ST depressions in V2 and V3. A right-sided electrocardiogram is also performed and shows elevated ST segments in V4R and V5R. Which of the following medications is contraindicated?
A 40 year old male with history of Marfan's Syndrome comes in with sudden onset shortness of breath preceded by tearing chest pain. He is tachycardic to 120, blood pressure is 80/40, patient is tachypneic with increased work of breathing. CXR is consistent with widened mediastinum and pulmonary edema and stat bedside ECHO is concerning for acute aortic regurgitation secondary to aortic insufficiency. Cardiothoracic surgery is consulted. What two medical modalities are contraindicated in this patient?
A. Beta Blocker and Intra-Aortic Balloon Pump
68yo Male, hx DM (+insulin pump), CHF (+lasix), HTN, presents to the ED c/o intermittent episodes of lightheadedness for the past year, becoming more frequent over the past month and had an episode today while getting out of bed. No syncope. At home noted HR 33, went to urgent care, HR 37. Patient was sent to the ED for further evaluation. What did the ECG show?
For the final week of our cardiology module, Dr. Lisa Filippone presented a great case. A 24 y.o. male playing basketball developed palpitations, lightheadedness, dizziness and almost 'passed out'. On arrival to the ED the patient looked well and had no complaints except for palpitations: HR 190, BP 130/70. Lungs were clear, heart without an audible murmur and neuro exam was unremarkable. ECG shown is shown. What is the diagnosis and treatment?
A patient presents in ventricular tachycardia with a blood pressure of 90 systolic. He is diaphoretic and complaining of chest pain. You decide to attempt electrical cardioversion and it fails. You attempts again....and again....and again....without success. You realize this is no ordinary VT...this is electrical storm. Read on for pearls on how to deal with this frightening and deadly condition.
This week at our EM/Cardiology interdisciplinary conference, Dr. Lisa Filippone presented a case of a 75 year old male who presented with acute SOB. This patient presented to the ED 3 days after a NSTEMI with hypotension and hypoxia. No injury pattern was identified on his ecg but his CXR was consistent with pulmonary edema. A bedside ECHO was performed that revealed the diagnosis....
Ever wonder if all of your patients presenting with recent onset (<48 hrs) atrial fibrillation and a rapid ventricular response really need to be admitted? Is there evidence of a safe and effective treat and street algorithm that EM physicians can employ? Read on for a review of the Ottawa Aggressive Protocol for rapid afib that enables discharge of 97% of patients!