The 1stannual Rebellion in EM Clinical Conference took place in San Antonio, TX on May 11th– 13th, 2018. If you missed out in 2018, the Rebellion is coming back June 28th – 30th, 2019. Stay up to date as we plan the conference for this upcoming year at www.rebellioninem.com. The Missions of Rebellion in EM: Decrease Knowledge […]
Archive for category: STEMI
A 52 year old female with a past medical history of type II diabetes mellitus and tobacco abuse presents with a chief complaint of chest pain.
According to the patient she had about 2 – 3 months of stuttering, substernal chest pain without any radiation. She described the pain as pressure-like, with activity, but that it would typically resolve after a few minutes of rest. Today she awoke with substernal chest pain that never resolved and continued in the emergency department. She quantifies her pain as 7/10 and not relieved with 2L nasal cannula of oxygen, 325mg PO aspirin, and SL NTG x3.
BP 127/89 HR 76 RR 20 O2 sat 100% on 2L NC Temp 99.3
Awake, A&Ox3, appears uncomfortable
Mild JVD on examination
RRR w/o m/r/g
2+ pulses in her extremities, no edema
ECG is shown (No prior ECG for comparison)…..
89 year old male with PMH of hypertension, stage 3 chronic kidney disease with chief complaint of shortness of breath. Several days ago patient had a laminectomy for radicular pain. He was doing fine post-operatively and began to develop gradual shortness of breath. He had no complaints of chest pain, nausea/vomiting, fevers, diaphoresis, but did have some weakness. There were no prior ECGs for comparison.
BP: 98/48 HR: 103 RR: 18 O2 on RA: 94% Temp: 38.6
JVD to the angle of the mandible
Bilateral lower extremity pitting edema
Labs: Na 125, K+ 4.2, Creatinine 2, BNP > 2500
ECG from triage is shown… Read more →