Comments on: Sphincter-Clenching Case

By: Rogue Medic

Rogue Medic — Fri, 10 Apr 2009 05:58:19 +0000

RVI is usually memorable. Almost the opposite of the rest of the STEMIs. Dump fluid into them until you think they can tolerate some NTG, then you are playing catch up, again.

I do not like giving pressors to any infarcting patient, but for RVI it is a fluid problem, not a catecholamine problem. Outside of the hospital the downside of pressors in RVI is too great. Anything with ST elevation in II, III, and aVF should be assumed to be RVI until proven otherwise. It is too easy to kill RVI patients.

Nice job and your nurse, too.

By: ERP

ERP — Wed, 08 Apr 2009 22:11:20 +0000

Leads II, III, and avF have a “tombstone” appearance to the S-T segments….

By: atyourcervix

atyourcervix — Wed, 08 Apr 2009 15:46:04 +0000

I do recovery room for OB related OR cases on L&D. So, needless to say, I don’t see abnormal EKG strips too often. Reading 12 leads? Totally not my groove. However, that 12 lead up above: I can definitely see prolonged QRS complexes. (I’m looking at V5) — absence of P waves, elevated T waves. Are the prolonged QRS complexes the “tombstones” that you’re referring to? As for the rest of the leads….totally lost on how to interpret them. Once again…..I’m only trained on simple 3 leads for the PACU.

By: MegRN

MegRN — Wed, 08 Apr 2009 01:25:05 +0000

Good thing you had good nurses who kept you updated on your patient!

By: Ted

Ted — Tue, 07 Apr 2009 23:16:52 +0000

I had a case exactly like that. Nothing except bradycardia on EKG, hypotensive….started dopamine and out came the tombstones.

By: JS

JS — Tue, 07 Apr 2009 17:39:58 +0000

I’m always glad when I put the defib pads on those pts too….had v-tach to many times to forget

By: ERP

ERP — Tue, 07 Apr 2009 16:36:41 +0000

Yeah, I was dreading having to start the nitro. If I did, I was going to start it at like 10- 20 mics and restart the Dopamine to support the BP if needed. Glad I didn’t have to go there….
Turns out he is now doing crappy up in the CCU in heart failure and heart block.

By: shadowfax

shadowfax — Tue, 07 Apr 2009 15:57:50 +0000

Great case. Funny — your lede was “raised my blood pressure,” and seeing that ECG I thought it was a neat play on words for the patient whose blood pressure was in the crapper.

RV infarctions are scary — good thing you didn’t turn on the nitro — Rv infarctions are really preload dependent and that would have dropped his blood pressure way way more.

I kind of like inferiors because patients look so *sick* it’s really gratifying to find the Dx and fix ‘em.