The following ECG was obtained from an independent 78 year old woman at 11pm who complained of left sided shooting jaw ache that had commenced earlier that morning. She is adamant she has no chest pain. She had taken a RAT test earlier in the morning because of myalgia and was day 1 COVID positive.
ECG of the Week 9th November 2022 – Interpretation
The most obvious abnormality is ST segment elevation in lead aVR with diffuse ST depression in most other leads (least in aVL but obvious in all others).
Lab case 386
85 years old lady with history of COPD, brought to ED with low GCS after VF cardiac arrest followed by return of spontaneous circulation after 3 minutes of CPR and a single DC shock. Her VBG on arrival showed:
PH = 7.222
Lab case 385 interpretation
Answers:
Question 1:
PH = 7.344, that is mild acidaemia.
HCO3 = 18.4 mmol/L (less than 24). So, we have metabolic acidosis.
Imaging Case of the Week 528
The chest x-ray is from a 30 year old patient with dyspnea. What can be seen? Continue reading
ECG of the Week 9th November 2022
A 60 year old man, who speaks little English, is triaged as a category 2 for left sided chest pain after being brought to hospital by ambulance. He has a history of the following:
- CMML under surveillance (he says “no treatment, just blood tests”, but can’t tell you who his haematologist is)
- Kidney Dysfunction (he can’t elaborate further)
- Hypercholesterolaemia (takes a statin)
- Reflux (takes a PPI)
Intranasal Topical Application of Tranexamic Acid in Atraumatic Anterior Epistaxis
Findings
- Intranasal topical TXA is associated with a lower rate of need for anterior nasal packing and a shortened stay in the ED
Bottom line
- Topical TXA for epistaxis is slowly gaining traction despite recent negative study (NoPAC)
- This RCT fits author’s own experience- ineffective for posterior bleeding, delayed presentations or traumatic epistaxis, but no harm and better tolerated than balloon tamponade device (RapidRhino etc)
Lab case 385
21-year-old girl with history of type I DM. Her BSL level at home was 37 mmol/L. So, she self-administered 10 units of Actrapid. She rechecked her BSL 1 hour later and it was 38 mmol/L so she decided to present to ED. On arrival to ED her VBG showed the following:
Lab case 384 interpretation
Question 1
PH = 7.47 that is mild alkalaemia.
HCO3 = 39.2 accordingly we have metabolic alkalosis
Next compensation: expected PCO2 = 0.7 x HCO3 + 20 (range: +/- 5).
0.7 x 39.2 + 20 = 47.4 (Range 42.7 to 52.7).
PCO2 is 57, that is higher than the expected PCO2 so we have additional respiratory acidosis.
Imaging Case of the Week 527
The chest x-ray is from a 14 year old who has presented with dyspnea. What can be seen? Continue reading