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We administered adrenaline for cardiac excitation, dopamine for maintained bloodpressure, sodium bicarbonate to correct the acidosis, and multiple electric defibrillations. However, the patient's cardiac Doppler ultrasound indicated poor cardiac contractions, and extracorporeal membrane oxygenation (ECMO) was started immediately.
He presented to the Emergency Department with a bloodpressure of 111/66 and a pulse of 117. One very useful adjunct is ultrasound: Echo of his heart can distinguish aneurysm from acute MI by presence of diastolic dyskinesis, but it cannot distinguish demand ischemia from ACS. He had this ECG recorded.
He had diffuse crackles on exam and B-lines on chest ultrasound, and chest x-ray also confirmed pulmonary edema. Bloodpressure was 215/124 and HR 115 (on metoprolol). Inferior LV "aneurysm" morphology Electrocardiographic "LV Aneurysm" morphology simply means "persistent ST elevation after previous MI."
Look for Vascular Etiology -- think of these while doing H and P: --Bleeding: ruptured AAA, GI bleed, ruptured ectopic pregnancy, other spontaneous bleed such as mesenteric aneurysms. Any ED systolic bloodpressure less than 90 or greater than 180 mm Hg (+1) 4. Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade.
Her bloodpressure on arrival was 153/69. There are no Q-waves to suggest old inferior MI, or inferior aneurysm as the etiology of the ST Elevation. I suspect pulmonary edema, but we are not given information on presence of B-lines on bedside ultrasound, or CXR findings. She arrived to the ED with a nonrebreather mask.
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