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

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
Steve Pike
Snapshot Case: What Happened?
Thus is the story with elective electrocution. If it works, it's medicine, if it doesn't, it's murder. Every shock shown was indicated, if you don't count the first one.
2015-05-28 22:49:42
Glenda
Snapshot Case: What Happened?
torsades des pointes! Electrolytes??
2015-05-28 16:56:49
Olivier
Snapshot Case: What Happened?
To support Donovan's analysis, QRS are remarkably thin and eventually consistent with paediatric findings. However, as noted, atrial fibrillation in very young patients are quite rare.
2015-05-28 07:36:54
Donovan
Snapshot Case: What Happened?
Looking back on the dosages, though, it occurs to me: this may be a pediatric patient. If that is the case, then for 50 J to be an appropriate dose for Shock 4 (again, assuming the patient is unstable), they would have to weight 25 kg. If that is the case, then the accidental induction…
2015-05-28 01:46:30
Donovan
Snapshot Case: What Happened?
1) Why convert the first rhythm? (brought up by a couple of commenters) -- As is posted in the initial: "required emergent cardioversion for unstable rapid atrial fibrillation" ... rate is not the determining factor about stability, the presence or absence of signs of shock are (hypotension, acutely altered mental status, ischemic chest pain, usw).…
2015-05-28 01:27:57

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