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This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chestpain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.
Colin is an emergency medicine resident beginning his criticalcare fellowship in the summer with a strong interest in the role of ECG in criticalcare and OMI. They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chestpain. Edits by Willy Frick.
This 54 year old patient with a history of kidney transplant with poor transplant function had been vomiting all day when at 10 PM he developed severe substernal crushing chestpain. He presented to the Emergency Department with a blood pressure of 111/66 and a pulse of 117. He had this ECG recorded.
If you saw this ECG only knowing that it is an acute chestpain patient, what would be your interpretation? There was high suspicion of OMI, so patient was brought to criticalcare area and another ECG was recorded just 7 minutes later as the pain had diminished to 4/10. Suspicious but not diagnostic.
There was no chestpain. Later, I was working in the ED and a patient was moved from a regular room to the criticalcare area due to recurrent hypotension. The patient was now under my care. So we did a bedside cardiac ultrasound. But today's patient had no chestpain.
She denied chestpain and denied feeling any palpitations, even during her triage ECG: What do you think? Despite otherwise normal vital signs, she was appropriately triaged to the criticalcare area of the ED.
A late middle-aged man presented with one hour of chestpain. Bedside ultrasound showed no effusion and moderately decreased LV function, with B-lines of pulmonary edema. Crit Care Med. 1991 May;19(5):694-9 Objective: To evaluate the efficacy and safety of potassium replacement infusions in critically ill patients.
A middle aged patient who was 3 weeks s/p STEMI came from cardiac rehab where he developed some chestpain, dyspnea and weakness on the treadmill. In the ED he had some continued chestpain and hypotension. 5 of 6 presented with chestpain and an ECG indicating reperfusion therapy, but were detected by bedside ultrasound.
Case 1: 20-something woman with chestpain Case 2: 50-something man with chestpain Case 1 A 20-something yo woman presented in the middle of the night with severe crushing chestpain. The blood pressure was 170/100 in the criticalcare area. Which patient needs a CT Scan? Denies SOB.
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