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Re: Hmmm

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  • Nikiah Nudell
    That sounds plausible... What would capnography look like in that situation? The high BP concerns me still... Nick ... -- Sent from my mobile device
    Message 1 of 23 , Jun 30, 2009
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      That sounds plausible... What would capnography look like in that
      situation? The high BP concerns me still...
      Nick


      On 06/30/2009, wegandy1938@... <wegandy1938@...> wrote:
      > There's no S1Q3T3 pattern or anything else to suggest pulmonary embolism
      > that I can see. He's tacky, so there's something happening but I agree
      > with
      > Paul that it's probably not cardiac. I have seen the strip, and it's sinus
      > with a LBBB and occasional PACs and one PVC. QRS axis is 60 odd. There
      > is one interesting thing. In leads I, II, III, and aVF the T waves are
      > sometimes properly discordant but at other times not. And it's not the
      > PACs
      > that are different. There are occasional sinus beats with a concordant T
      > wave. the Qrs looks the same. Now I don't have a clue what this means.
      > I
      > also don't see how it reflects anything that's causing the dyspnea.
      >
      > Could this guy have just produced a bunch of mucus and not been coughing
      > because of the soreness from the hernia and there was a mucus plug or
      > something? The fact that he got better suggests that something "moved" or
      > crawled
      > back into its cave. But the greatly diminished left side lung sounds
      > trouble me. Pneumo?
      >
      > All the time his CO2 was about 45 or so with a nice waveform.
      >
      > Also I don't see the correlation with the BP unless it was pure
      > catecholamine related due to his dyspnea.
      >
      > Anxiety attack?
      >
      > I'm probably full of it, but that's all I can come up with. Somebody HELP
      > ME! LOL.
      >
      > Gene G.
      > In a message dated 6/29/09 7:57:53 AM, PMATERAMD@... writes:
      >
      >
      >>
      >>
      >>
      >> hi i cant see ecg either i will go by case presentation and vitals and
      >> descriptions of the ecg by others,,, in general he is 48h sp surgery and
      >> he
      >> has plenty of bp therefore a direct cardiac cause of his sob is unlikey,
      >> he
      >> is sp surgery so pe is possible, he is struggling to maintain his O2
      >> delivery with low pulse ox and reversible with O2 and peep point to a
      >> pulmonary
      >> parenchyma issue, pe, peumonitis, pneumonia, pneumo, pulmonary edema,
      >> etc.,
      >> he has a pulse and has excellent bp then this is unlikely a primary
      >> cardiac
      >> output issue and I would seriously resist any attempt at rate control with
      >>
      >> any med as this is likely to make the sob worse (ie reduce the already
      >> reduced pulmonary perfusion) ie we dont try to fix what is not broke,
      >> any jvd filling from below, pulsus paradoxicus, sub q emphysema, etc
      >>
      >> Paul
      >>
      >> Paul A. Matera, MD, D-EM, D-IM, EMTP
      >> Clinical Associate Professor - George Washington University, D.C.
      >> Director Emeritus - Critical Care Units, Providence Hospital, D.C.
      >>
      >>
      >> In a message dated 6/28/2009 5:14:16 P.M. Eastern Daylight Time,
      >> medicnick@... a messag
      >>
      >> [Attachment(s) from Nikiah Nudell included below]
      >>
      >>
      >> Second attempt for JD.
      >> Thanks,
      >> Nick
      >>
      >> ---------- Forwarded message ----------
      >> From: Nikiah Nudell <medicnick@...>
      >> Date: Sat, 27 Jun 2009 23:49:10 -0400
      >> Subject: Hmmm
      >> To: ekg_club@yahoogroupekg_c
      >>
      >> Attached you'll find a case of a 67 year old male two days post open
      >> abdominal hernia repair. He experienced 45 minutes of sudden onset SOB
      >> while
      >> resting at home. Denies HA, CP, abd pain, or any symptom other than
      >> difficulty breathing.
      >>
      >> His BP is 220/140, BGL 210, RR 40s, skin pale, warm/hot, moist. Airway is
      >> patent although retractions are visible. Left lung sounds very diminished,
      >> right side intially with wheezing changing to coarse rhonchi during care.
      >>
      >> 12lead, rhythm strip and EtCO2 attached. Past medical history of AAA with
      >> aortic valve replacement & HTN reported. Patient takes coumadin, flomax,
      >> lisinopril, and cardizem. Pt allergic to ASA and PCN.
      >>
      >> What say ye?
      >>
      >> Cheers,
      >> Nick
      >>
      >> --
      >> Sent from my mobile device
      >>
      >>
      >>
      >
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