Here we go with what I hope will become a regular feature of the St. Emlyn’s blog – a cardiology case of the month. This is something I’ve been running for short while in my department, so it makes great sense to start sharing the cases with a wider audience, in the interests of #FOAM.
I certainly can’t promise to live up to the genius of Amal Mattu or Steve Smith, but still I hope you’ll find this a worthwhile feature! They’re the scribbles of a busy academic emergency physician so please bear with me if there are one or two typos. The details will be based on real cases from my experience but, in the interests of confidentiality and after speaking with our data protection experts, key details will always be amended to ensure that no patients are identifiable. On to case 1…
A 45 year old man is brought to hospital by paramedics after being found by passers by sat on the roadside. The paramedics can’t obtain a coherent history and score his GCS as 13/15 (E3V4 M6). They perform an ECG and transport him to hospital.
On arrival the patient is agitated and non-compliant, has a blood pressure of 90/40, a GCS of 13 and 2mm equal and reactive pupils. You elicit generalised abdominal tenderness with guarding. The patient denies chest pain.
The ECG is below…
Hope you enjoyed the case. This is the first, hopefully of many, so all feedback is very gratefully received.