A 40 yo female is brought into the emergency department. The patient is unresponsive, hypotensive, and tachycardic. EMS providers are assisting ventilations with a bag valve masked and have attempted defibrillation without success. Paramedics state that the patient was somnolent prior to the arrest and has no cardiac history. A 12 lead ECG is obtained upon arrival at the emergency department.
BP: 80/50
P: 150
R: 12/assisted
Spo2: 100% via BVM
What are your thoughts on the 12 lead?
What is your next course of action?
WCT @ 170ish, RBBB + right axis + profound terminal R in aVR.
ReplyDeleteWould love a history to include evidence of Na-channel blockers / TCA OD. The somnolence gives some credence to the possibility of a TCA OD (or TCA as part of a polypharmacy OD). Bicarb would be a reasonable treatment choice, followed by lidocaine if the electrical storm continues.
Looks like I'm following you around on this site now Christopher!
ReplyDeleteMy first though on seeing this EKG was sodium-channel blockade as well.