The following ankle x-rays are from a 10 year old with inability to walk after a fall. What can be seen? Continue reading
65 year old female presents with collapse and sudden onset SOB
A 65 year old female presents to ED after acute onset SOB and collapse at home.
The following chest x-ray is from a 21 year old with chest and lower abdominal pain. What can be seen? Continue reading
A 46 year old lady presents following collapse. She has compensated shock and blood tests which show:
Severe compensated metabolic alkalosis with severe hypokalaemia/ hypochloraemia, moderate hyponatraemia and elevated lactate.
All suggest chronic diuretic abuse (Frusemide/Thiazide).
ECG findings of hypokalaemia include ST segment sagging, T wave depression, and U wave – changes which get more pronounced as the K falls. Starts at K<3
- Increased amplitude and width of the P wave
- Prolongation of the PR interval
- T wave flattening and inversion
- ST depression
- Prominent U waves (best seen in the precordial leads)
- Apparent long QT interval due to fusion of the T and U waves (= long QU interval)
With worsening hypokalaemia…
- Frequent supraventricular and ventricular ectopics
- Supraventricular tachyarrhythmias: AF, atrial flutter, atrial tachycardia
- Potential to develop life-threatening ventricular arrhythmias, e.g. VT, VF and Torsades de Pointes
manage in resusc
Full cardiac monitoring
Prepare for unstable arrhytyhmia
Fluid and K replacement – req central access and arterial BP monitoring
A 46 year old female presents after a collapse. She has no prior medical issues.
RR 14/min Continue reading
The right forearm x-rays are from a 3 year old following a fall on outstretched hand. What can be seen? Continue reading