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Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chestpain for 3 hours prior to arrival. At this time he reported ongoing chestpain and was given aspirin and nitroglycerin. J Am Heart Assoc.
This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. She was defibrillated and resuscitated. It can only be seen by IVUS.
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.
She did notice something slightly wrong subjectively, but had no palpitations, chestpain, or SOB, or any other symptom. Her bedside cardiac ultrasound was normal We decided to cardiovert her since the time of onset was very recent. Her Apple Watch suddenly told her that she is in atrial fibrillation. She was on no medications.
They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chestpain. They described the chestpain as severe, crushing, and non-radiating. Altogether, this strongly suggests inferolateral OMI, particularly in a patient with acute chestpain.
Written by Pendell Meyers and Peter Brooks MD A man in his 30s with no known past medical history was reported to suddenly experience chestpain and shortness of breath at home in front of his family. It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. Now another, with ultrasound.
The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chestpain. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck. He required multiple defibrillations within a period of a few hours. What do you think?
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. Most recent echo showed EF of 60%. He also had a history of chronic kidney disease, stage III. He had recently had a NonSTEMI. He appeared to be in shock.
After epinephrine, atropine, and defibrillation x 2, there was a return of pulses. Patients who present with chestpain or cardiac arrest and have an ECG diagnostic of STEMI could have myocardial rupture. 5 of 6 presented with chestpain and an ECG indicating reperfusion therapy, but were detected by bedside ultrasound.
The patient denied any chestpain whatsoever, and a troponin at zero and 2 hours were both undetectable. A bedside cardiac ultrasound revealed grossly normal to hyperdynamic systolic function with no obvious areas of wall motion abnormalities. Is this Type 2 Brugada syndrome/ECG pattern?
A middle-age woman with no previous cardiac history called 911 for chestpain. On arrival in the ED, a bedside ultrasound showed poor LV function (as predicted by the Queen of Hearts) with diffuse B-lines. We rapidly defibrillated her, and with return of normal sinus rhythm. Chest X-ray also showed pulmonary edema.
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