Happy Holidays avid Rhythm Nation followers! Time for the December edition of the blog. This month’s will be a little different but still should be interesting nonetheless! Here is our case:
A 57 year-old man with PMH of HTN, DM, HLD, MI, methadone dependence and ESRD was transferred from his dialysis center after syncope midway through dialysis. Upon arrival to the ED, the patient was found mildly somnolent and bradycardic but otherwise was asymptomatic. His heart rate would increase when he was aroused.
Exam:
VS: 160/84, 85, 20, 97%, 97.6
Gen: NAD, A&Ox3, mildly somnolent
HEENT: PERRLA, pupils 1-2mm BL
CV: Bradycardia, No m/g/r. Chest wall dialysis shunt c/d/i
Resp: CTAB
Abd: soft, NTND
Extrem: no edema
Initial ECG showed the following:
The patient was placed on cardiac telemetry and blood samples were sent. While patient became somnolent, a nearby resident noticed the following rhythm strip on the cardiac monitor:
(image brought to you by Dr. Freedman)
Questions:
- Please identify the rhythm on the monitor and suggest a differential.
- Please identify the patient’s risk factors for this rhythm and how they causes it.
- What immediate treatment is warranted?
carmellig
Latest posts by carmellig (see all)
- Creating Visually Stunning and Effective Presentations! - April 26, 2017
- Endophthalmitis Diagnosis and Treatment - December 22, 2016
- Rhythm Nation: August 2016 ANSWER - September 7, 2016
0 Comments