76 year old female, presents with lightheadedness and lethargy. She is complaining of mid-scapular pain & is syncopal at triage.
She has cold hands & clammy skin. Systolic BP 70 mmHg. Crackles to mid-zones of her chest. Distended JVP.
PMHx: AF (on metoprolol) & rheumatic heart disease (?mitral stenosis)
This is her ECG.
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My interpretation of the ECG;
Sinus rhythm with 1st degree HB, an ‘odd’ axis. Wide complex QRS (~140-160ms) with symmetrical tall T-waves.
? Hyperkalaemia. Needs urgent bloods….
The nurse returns…
No one can place an IV or take bloods from her. So off you go, USS in tow to the bedside.
IV placed; bloods taken; urgent VBG to the iStat…..