78 yof patient in a skilled nursing facility S/P CVA. Patien | Figure 1

Case Summary

78 yof patient in a skilled nursing facility S/P CVA. Patient is contracted and aphasic. Staff called due to patient having decreased level of consciousness and bradycardia. Patients initial BP was 92/50 with the rhythm shown above. Metoprolol was on the MAR and IV access was already in place. 1mg glucagon administered IV. The 2nd ECG is after administration of glucagon. Patients BP and responsiveness improved. NS administered and patient transported to closest ED.

Additional Cases

Do you agree with the monitor's interpretation? Pt was in the shower for approximately 45 minutes before a caregiver went to check on him, and found him sitting on the floor of the shower, unresponsive. Caregiver called 911. Pt was cold and wet, BG 34, BP 138/64, SpO2 91%, EtCO2 of 26, bradycardic in the 40s with strong/equal pulses. IV, O2, Glucagon, Dextrose in the field. Mentation improved en route, no complaints from pt. Pt found to have a temp of 89 upon arrival at the ER. View Case

This came out of a patient’s PICC line with LR immediately after administering #Labetalol. The patient was given IV fluorescein earlier, what factors could have caused this? View Case

A 45-year-old man with known history of anaphylaxis to Hymenoptera stings is stung while gardening and rapidly develops facial angioedema, diffuse urticaria, and wheezing. He self-administers autoinjectable epinephrine and presents to the emergency department (ED). On arrival to the ED 15 minutes later, his symptoms have not improved. The next step in treatment is:

A degloving injury secondary to Road Traffic Accident. Patient is a 28 years old who was traveling on a motor bike along two other (three on bike including the rider) when they were hit from behind by a truck. Patient was rushed to A&E hours after the accident and conscious. Debridement was done and cephtriaxone IV was administered. Patient however died 48 hours later from sepsis. View Case

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department. View Case

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area. View Case

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest. View Case

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family. Are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG? View Case