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CT of the chest showed no pulmonary embolism but bibasilar infiltrates. Discontinue all negative chronotropic agents, since the risk of torsade is much higher with bradycardia or pauses. She was intubated. Bedside cardiac ultrasound showed moderately decreased LV function. The plan: 1. Place temporary pacemaker 3.
See these publications for more information Overall, management for cardiac contusion is mostly supportive unless surgical complications develop, involving appropriate treatment of dysrhythmias and hemodynamic instability. Other Arrhythmias ( PACs, PVCs, AFib, Bradycardia and AV conduction disorders — potentially lethal VT/VFib ).
Bedside ultrasound showed no effusion and moderately decreased LV function, with B-lines of pulmonary edema. There is also bradycardia. Bradycardia puts patients at risk for "pause-dependent" Torsades de Pointes. Bradycardia puts patients at risk for "pause-dependent" Torsades de Pointes. Learning Points: 1.
PVCs N ot generally considered abnormal ECG findings: Isolated PAC, First Degree AV Block, Sinus bradycardia at a rate of 35-45, and Nonspecific ST-T abnormalities (even if different from a previous ECG). Thus, if there is documented sinus bradycardia, and no suspicion of high grade AV block, at the time of the syncope, this is very useful.
His rhythm on telemetry seemed to be sinus bradycardia vs junctional rhythm. It did not show pulmonary embolism or intra-abdominal pathology, but it did show this: See the dark area at the bottom of the image? There was no pulmonary embolism. A quick POCUS which showed significantly reduced ejection fraction and trace B lines.
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