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Wednesday, 23 July 2014

ECG Class - Summer 5 - Intro

Welcome!
If you are new to @ECGclass, before we start, you may like to read this brief explanation of what it's all about: #ECGclass and how it works.
Each 'term' is spilt into 5 cases, launched a 2 weekly intervals.
So here goes with the next case of this term!

This weeks case is brought to you by Sy.

Final ECG Class for the Summer.

This is a case for everyone it could be an out of hours call, walk in centre, GP surgery, ambulance or emergency department.

Patient assessment

History: A 35year old female brought in by a friend/seen at home. She report increasing pain in her back and shoulders for the past two days.
Past medical history: fibromyalgia, asthma
Drugs: Amitriptyline (25mg ON), Paracetamol (1g QDS), Zomorph (10mg BD), Salbutamol inhaler (PRN).
Social: Lives alone.
On examination: The patient is lethargic & dizzy, and responding to verbal commands
Sats: 93% on air
Resps: 18. Equal bilateral chest expansion with slight bilateral wheeze
Pulse: 100 regular
BP: 95/50 both arms
Good colour
Central capillary refill time = 3 seconds
Temp: 36.4
GCS: 13 (E3, V4, M6). Our patient is responding to voice.
Pupils: Equal 4mm round and react to light
Glucose: 4.8
This is a young person with hypotension, tachycardia and a mild tachypnoea as well as an acutely altered mental state. This is an unwell person requiring close monitoring and urgent attention to stop further deterioration.
At this point we are unsure about what is happening so as soon as possible we would ask for general bloods, blood cultures (think sepsis as pulse>90 + acutely altered mental state ? pneumonia due to the decreased sats), ECG and a blood gas.
Given this is a blog about ECGs I’m sure you will have guessed the ECG will be the key to diagnosing this patient…

ECG

Larger version of the ECG at this link

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