53 YOF with AMS: STEMI or Secondary ST-T Changes?

This is the case of a 53 year old female who presented to the Emergency Department (ED) via EMS, with Altered Mental Status (AMS).

EMS was called to a local dialysis center due to the patient being unresponsive after approximately 3 hours of dialysis.

Upon arrival to the ED, the patient was unable to answer questions, with a Glasgow Coma Scale (GCS) of 8 and the following baseline vital sings:

  • Heart Rate: 74 beats/min, strong and regular

  • Respiratory Rate: 15 breaths/min, adequate tidal volume and regular, with clear sounds

  • Non-invasive Blood Pressure: 202/76 mmHg

  • SpO2: 99% on 15 LPM via Non-rebreather

  • Pupils: 3 mm and reactive to light

  • Blood Glucose Level: 68 mg/dL

Known Medical History:

  • Hypertension (HTN)

  • Chronic Renal Failure

No know allergies.

The following 12 lead ECG was obtained by EMS prior arrival to the ED:

lvh osceola web

(Click on the ECG for a full view)

  • What is your detailed ECG interpretation?
  • What is your treatment?

Click HERE  for the conclusion:

 

 

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EMS 12-Lead

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Comments
Ken Grauer, MD
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Digoxin is used much less frequently these days than in the past - when it was a drug that virtually every patient with heart failure was taking. As a result - many clinicians in modern times are far less familiar (and comfortable) with how to dose Digoxin. Digoxin pharmacokinetics are linear - You double the…
2015-04-16 03:27:43
Ralph A
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Oh that was great....!!
2015-04-11 01:34:07
Ivan Rios
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I like your thought process. A Its not that Amiodarone is contraindicated in Hyperkalemia. In the event of arrest, Hyperkalemia usually leads to PEA and asystole. The Hyperkalemic effects on Action potential and Sodium potassium atpase channels should be addressed first in order for Amiodarone to work effectively. Once this is achieved, proper depolarization and…
2015-04-09 18:28:22
C galliher
Understanding Amiodarone
I hate cook book medics. I just do what my protocols say”.
2015-04-09 18:25:40
Chris g
Understanding Amiodarone
Cook book medic. I just do what my protocols say”.
2015-04-09 18:24:27

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