Friday, August 13, 2010

Next Step

Yes, I've shown a similar EKG before, but I had to write this case last minute. A 70 year old man who has never seen a doctor before presents with chest pain and the EKG shown above.

Challenge: What's your next step in management?

Image is in the public domain.

1 comment:

Craig Chen said...

Next Step

This is (presumably) a new left bundle branch block. It is treated like an acute MI. ACLS guidelines suggest: Stabilize airway, breathing, circulation. Oxygen, cardiac and saturation monitors, IV access. ASA 325 chewed (or PR). Troponins, electrolytes, coags, Hgb, Hct. NTG tab and/or gtt (40mcg/min), consider loop diuretic. prn SL NTG (0.4mg q5min or aersol spray). Metop 25mg PO. Morphine 2-4mg slow IVP q5-15min. Atorvastatin 80mg. PCI or fibrinolysis if PCI unavailable. Antiplatelet therapy (prasugrel, clopidogrel, glycoprotein IIb/IIIa) and anticoagulant therapy (unfractionated heparin, bivalirudin, enoxaparin).

Sources: UpToDate; ncbi.nlm.nih.gov.