A 19 yo male PMH sickle cell disease presents with body aches and joint pains x 2 days. Symptoms feel similar to prior acute vaso-occlusive crises. On ROS, he also notes chest pain and SOB starting 1 day prior to arrival. He is afebrile rectally, SaO2 95% on room air, and chest x-ray shows no consolidation. Initial ECG is below.
Chest pain and SOB persist despite conservative management. Repeat ECG is below, 3 hours after the initial.
Shortly after the repeat ECG, the patient becomes progressively tachycardic and hypotensive.
Interpret the second ECG, including any changes from the initial.
What is the diagnosis?
How would you manage this condition?
The following two tabs change content below.
yon.yohannes
Latest posts by yon.yohannes (see all)
- The Critically Ill “Tox Patient” - June 2, 2016
- Shoulder Dislocations in Austere Environments – A Novel Approach - May 12, 2016
- Management of Atrial Flutter with Rapid AV Conduction - March 16, 2016
1 Comment
Sebastian · November 25, 2015 at 2:50 pm
Looks like PE: he has a appropriate history ( sickle cell disease), typicall clinical signs ( SOB, chest pain, no fever) and progressing signs of right ventricullar strain ( tachycardia, S1Q3, incomplete right fascicle block, negative t an descending st in his anterior leads).
Should consider other causes of acute pulmonary hypertension than embolic ones.