Nightmare EKG!!!

I know I know……your probably hoping you NEVER see this EKG, but what if you do? What is this???  How would you treat it?  Would it make a difference if the patient was stable or unstable?

What would you do?

So imagine this clinical situation…

You just came on shift in the emergency department.  Your partner has just finished telling you about the COPD patient he had to intubate when the nurse for the patient  comes rushing out and says “somethings wrong doctor, come quick!”  Your partner quickly says “I’m out!”

You enter the room and find the “new” respiratory therapist at the bedside.  He tells you that the patient is increasingly hard to ventilate and the plateau pressures are very high.  What would be your immediate first step?

Whats Wrong Here???

I read a story yesterday in the news about a Columbus man who collapsed during the Columbus half-marathon.  He was taken to Grant Hospital in full arrest.  He was successfully resuscitated and is, according to the news story, still alive.  When they did his EKG they discovered he had Brugada Syndrome.  I thought it might be useful to review a few important details about Brugada Syndrome in this week’s “in the news.”

Previous Post

I know what you are thinking…….he’s blogging about another rash!  I think this one though is an important one to recognize and treat.  Besides, so many of you have said to me “I’m really bad at rashes!”

What do you think this rash is?  What characteristics of this rash make it readily identifiable?  If you saw this patient what specific questions would you ask?  How would you treat it?

Conference Notes

Yesterday in our resident conference, we had an excellent diversity talk by Dr. Gabriel Schifman entitled: Diversity in the ED, Lesbian, Gay, Bisexual, and Transgender Youth.  Dr. Schiffman is a pediatric emergency physician at Nationwide Children’s Hospital.  I wanted to summarize some important points from this talk.

This can’t be good!

The clinical scenerio goes something like this:  35yo male comes in with a swollen finger.  Several days ago he sustained a minor cut to the volar surface of his 2nd digit.  He  noticed over the next few days  increased swelling and redness.  He has a fever on exam.  What is the diagnosis?

Ugh! Another Rash???

This 10yo patient presents to your emergency department with a rash and diffuse abdominal pain.  Mom says the child has complained of nausea, vomiting and joint/body aches.  The child is febrile on exam and has the rash in the picture above.

Think for a minute what other questions you would want to ask………

X-ray Quiz: Foot pain

Your patient is a 35yo male who presents to the ER with the complaint of foot pain.  You learn that the patient sustained a fall from 10 feet landing upright.  On exam you note that the patient has pain over the calcaneous.  The X-ray is shown above.  Do you notice the abnormality?

Is It V-tach?

This is an interesting case I wanted to share with you.  This was an older person with a wide complex tachycardia.  The most important thing from this case I want everyone to know is that you will never go wrong by treating these patients as if the rhythm were ventricular tachycardia.

Death Telling

This is something I wrote last year, but I think its relevant to what was presented in conference today.  I wasn’t able to attend, but here’s my thoughts on the subject.

I remember the first time I ever told a family that their loved one had died.  It was my first year of residency.  The patient arrived in cardiac arrest.  Despite multiple rounds of ACLS we couldn’t get a pulse back.  At the end, my attending asked me if I wanted to talk to the family.  I confidently said “sure” and nervously walked back to the family room where pastoral care had taken them family.