SAQ 2: Resuscitation

1. 54 years male is brought in the ED with unresponsiveness and no signs of life. There is no pulse and the monitor shows the rhythm below. He was lying in cold snow on the street for unknown duration. What is your next steps of management? (2 marks)



2. His temperature is 29 Celsius. What different steps you would take specifically in this case? (4 marks)

3. He has a pulse now and is still unconscious. What are tasks in the post resuscitation scenario? (4 marks)

SAQ 1: Resuscitation

1. Describe the EKG? (2)

2. What are the Unstable features related to the diagnosis? (2)

3. Assuming the BP is 120/90, RR is 16/min, and SpO2 is 94 % on 2 liters of Oxygen and IV Access is obtained; what is your initial management? (2)

4.Your initial treatment does not work, and the patient arrests; monitor shows the same rhythm but there is no palpable pulse. What is your initial management? (2)

5. List the reversible causes of cardiac arrest (2)

Question: Cardiology

A 25-year-old otherwise healthy male patient form Thailand presents with 5 day history of a mild shortness of breath, without chest pain. He gives history of travel recently from Thailand to the UAE about 15 days ago. The vital signs were stable. A chest x-ray appears to be normal. His wells score for DVT is low. D dimer levels were found to be 400 units. An electrocardiogram (EKG) is ordered and is shown in Figure below. Which of the following is most likely?

Multiple Choice Responses

1              The patient's potassium level is decreased.

2              The patient has an increased risk for sudden cardiac death.

3              An echocardiogram would likely reveal significant underlying structural heart disease.

4              The patient has an ST-elevation myocardial infarction (STEMI) and needs an emergent heart                 catheterization.

5              The possibility of pulmonary embolism is high and the patient needs CT angiography

Answer:

This patient’s EKG reveals classic or “type 1” Brugada syndrome. Brugada syndrome is characterized by a pseudo-RBBB and persistent ST elevation in V1–V3. There are three unique patterns of ST elevation consistent with Brugada syndrome. In type 1, the elevated ST segment is convex facing upward, and gradually descends to an inverted T wave. This is referred to as a “coved type” Brugada pattern, and is most common. Types 2 and 3 have identical patterns, in which the elevated ST segment (>1 mm in type 2, >1 mm in type 3) first descends and then rises again after nearing the baseline, creating a “saddle back” appearance. It is associated with an upright or biphasic T wave. Brugada syndrome is not normally associated with any structural abnormalities. Most “standard” cardiac tests, including echocardiography, stress testing, and cardiac MRI are unrevealing. However, patients are at a much increased risk for sudden cardiac arrest due to ventricular arrhythmias. Unlike patients with hypertrophic obstructive cardiomyopathy, sudden cardiac arrest is not typically due to exercise and more commonly occurs in sleep. Most patients with Brugada syndrome undergo electrophysiology testing to determine their risk for cardiac arrest as well as the need for an automated implantable cardioverter-defibrillator.

Further Reading Medscape