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Sunday, June 8, 2014

Purple Pacer People: Does the 12 Lead ECG Show the Whole Story? 1/2

CASE PRESENTATION 

CC:          SOB

HPI:         80 yo male with sudden onset SOB during walk. Pt recalls feeling sick and then experienced syncopal eposide. Pt denies CP. Denies recent illness.
EXAM:    Pale, anxious, diaphoretic. VS: BP: 107/70, P: 107, R: 20. Sp02: 89%. Pt retracting; clear lung sounds.
ASESS:  Severe respiratory distress
PLAN:     Vitals, 12 lead, high flow oxygen, fluid bolus, 324 mg ASA



12 LEAD ECG


12 LEAD ECG RHYTHM STRIP







EMS and ED COURSE

The providers package the patient for transport. The patient becomes progressively more short of breath. Truncal cyanosis appears and is refractory to high flow oxygen. The patient has seizure-like activity upon arrival to the ED. Compressions are started and the patient expires following thirty minutes of failed reususcitation. 

What clues are provided by the patient's history or 12 lead ECG?