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Archive for June 2012

35 year old man with seizures

A 35 year old man is brought to the emergency department following two seizures. His GCS is 8 and his BP is 75/40 supine He has an ECG. Describe and interpret what might be going on. INTERPRETATION Rate: 120 Rhythm: Unable to see many p waves. There are retrograde P waves in V2. The P’s…

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68 year old with palpitations

A 68 year old male presents with one hour of rapid palpitations. ECG1 is taken before antiarrhythmics are given and ECG2 after treatment. Describe and interpret the ECG’s. ECG 1 Using the ECG in 20 Seconds Method so we don’t miss anything: Rate: 29 x 6 = 174 Rhythm: There are no P waves to…

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Thermal Burns

I was recently looking at a past ACEM Fellowship Examination Question on burns and thought it would be a great way to do some quick revision. Here is a photo: So here are some questions Describe the photo What surface area of burns are there? How do you calculate surface area? How do you calculate…

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54 year old male with chest pain

A 54 year old male with no past history presents with one hour of chest pain. He is anxious and diaphoretic. His BP is 100/60 supine, respiratory rate is 28/min and sats are 99% on 10L/min of O2. Here is his ECG. INTERPRETATION Using the ECG in 20 Seconds Method Rate: (25 x6) = 150…

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64 year old male with resolved chest pain

A 64 year old male has presented to the emergency department following an episode of chest pain, which has now resolved. His BP is 140/85, RR is 20 and saturations are 97% on room air.` He has an ECG. Please interpret. SOLUTION Using the ECG in 20 Seconds approach: Rate: 48 bpm on this ECG…

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25 year old male with chest pain

A 25 year old male with chest pain presents to the Emergency Department. Interpret this ECG. Using the ECG in 20 Seconds method Rate: 96 bpm Rhythm: P waves present. Look at P waves. Are they up in II and inverted in aVR? No they are not! This may be limb lead reversal. Look at…

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70 year old with syncope

A 72 year old woman is brought to your Emergency Department after a syncopal episode a. Describe and interpret her ECG (50%) b. Outline your disposition considerations (50%) Using the ‘ECG in 20 Seconds’ Approach: Rate: 66 Rhythm: P waves present before each QRS QRS: widened and RBBB pattern Axis: Left axis ST-T: Normal PR/QT:…

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Labs Example 1

Interpretation on ABG’s- Click above to watch a 12 minute video on interpretation of ABG’s. Example 1 INTERPRETATION This is an elderly man with vomiting for 3 days, who presents with tachycardia. It would be expected that there be a metabolic alkalosis with loss of gastric contents. He is on 50% oxygen. His pH shows…

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30 yo female with OD

Interpretation The information we are given tells us that this is a probable overdose, but don’t be limited to just that. The important thing to pick up is that the patient is now hypotensive. Rate: 120 Axis: Normal P waves: Very difficult to see, although in aVF, there may be some there. QRS: Widened, with…

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