shades of grey…

A few days ago I was looking after a 31/40 gestation restrained passenger from low-speed MVA with a slight seatbelt abrasion in her RIF & mild suprapubic pain. She looked well, HR 70 with BP 108 systolic and no features of peritonism.

As I placed the US-probe on for her FAST, this was the first image I acquired…..

   

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more than man-flu (part2)…

Here is the follow-up to the story of our 19 year old febrile patient…..

The case continues…

His CXR demonstrates the following ….

  • Clear lung fields
    • No pneumonia
    • No CCF
  • is that a ‘globular heart’  ??
  • This is his ECG…

    Sinus tachycardia. Non-specific T-wave changes, but no ST-segment changes.

    My thoughts at this stage were;

    • 19 year olds should be able to stand on their own
    • Constitutional symptoms… ?viral illness
    • I cannot exclude concomitant sepsis –> so treated with empiric ABx / fluids
    • Globular heart silhouette

     ** Is this myocarditis ?? **

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    supply & demand…

    Case:

    74 year old female is placed in the acute-area of our ED with a complaint of retrosternal chest tightness at approximately 9am. Her symptoms sound very typical for ACS. She looks clammy and pale.

    My colleague has placed her on telemetry, high flow oxygen and has prescribed 300mg aspirin &  600mcg sublingual anginine.

    I am handed her ECG, which shows a sinus tachycardia and evidence of left ventricular hypertrophy with a repolarisation pattern. Of concern is the associated anterior ST depression, so I make my way to the bedside….

    …as I approach her bed I witness her telemetry deteriorate from a sinus tachycardia to ventricular fibrillation !!

    There is a defibrillator 15 metres away, across the department. The following takes place…

    • Precordial thump (by me. did nothing except hurt my hand).
    • Immediate CPR until defib pads placed.
    • 200J shock
    • 2 further minutes of CPR with 1mg IV adrenaline.
    • 3 minutes post arrest she has return of spontaneous circulation.

    Cardiology are notified of this and want her in their Cath-lab immediately….

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    first time wheezer…

    I have recently heard the quote, “the eyes do not see what the mind does not know” & feel it is incredibly applicable to this particular case, which some of you may have seen recently in one of my Tweets.

    A 10 year old Samoan presents to our ED with ‘asthma.’ She is febrile (39.4*C), tachycardic at 124 / min (sinus), with a systolic BP of 124 mmHg & has room air saturations of 93%. She is wheezy, no doubt about it; and has a prolonged expiratory phase with pursed lip breathing. However, she is also clammy and pale. Her grandfather reports this is the first time she has had “asthma”, let alone any other respiratory illness. He also mentions that the GP has been treating her for “gout” over the past 1-2 years.

    I am asked to review her at 5am as her salbutamol therapy does not appear to be helping. My routine is to xray all ‘first time wheezers’ especially if the story is a little odd. This is hers…

    Image

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