From Emergency Medicine News by Swaminathan, Anand @EMSwami. Dr. Swaminathan is an assistant professor of emergency medicine and the assistant residency director of the NYU/Bellevue Emergency Medicine residency. He is the co-creator of the EM Lyceum blog (http://emlyceum.com) and the editor and chief of the Core EM blog (www.coreem.net). His interests are in resuscitation, residency education and knowledge translation. You’re working the overnight shift, it’s 6:15 a.m., and you’re starting to dream of a breakfast sandwich and bed. But, no, it’s your lucky morning, and in rolls a 55-year-old man in acute respiratory distress. He is hypertensive, tachycardic, and tachypneic. A quick bedside ultrasound reveals bilateral B lines that convince you that the patient is in acute pulmonary edema (APE) or acute decompensated heart failure (ADHF). The 12-lead ECG reveals only sinus tachycardia, and your nurse asks you how much furosemide you want to give. Congestive heart failure is a common proble…
Another post from our senior residents in EM - Dr Koh Shao Hui.
It is a quiet Monday morning in the resus room. Suddenly the VHF radio crackles to life: “48, yr old, Indian male. Standby for AMI. ETA 10 mins”
A 12 lead ECG is faxed over by the paramedics
What does the pre-hospital ECG show? The team prepares for the arrival of the patient.
Patient arrives with rhythm strip on board ambulance. (Together with strip done at OPS)
Additional history: Chest pain radiating to left arm since last night. Worse this morning occurring even at rest. A/w diaphoresis. Went to OPS, conveyed here by SCDF. PO aspirin 300mg loaded en route.
O/e: Alert, Diaphoretic, cold and clammy peripheries. L: clear. H: dual heart sounds, no murmurs. Pulses equal. Calves supple. No pedal oedema
Vitals: BP 160/74 HR 70 spo2 98% on RA
Defib pads put on stat with continuous cardiac monitoring.
This edition of webucation was slightly delayed due to holidays but we're back with pearls from surgical trauma, cardiology updates and even a funny xray of sorts... As always visit and support the content creators.