Monday, May 23, 2011

Pre-Op I

This week's cases will be things seen in pre-operative clinic.
A healthy 55 year old gentleman is scheduled for a laparoscopic cholecystectomy for symptomatic cholelithiasis. He has not seen a doctor in ages but is "otherwise healthy." He has never had surgery before. He takes five herbal medications for "general wellness." He has no allergies. He smokes marijuana daily, but does no other alcohol or drugs. His vital signs are all within normal limits. His Mallampati score is II, he has good neck range of motion, and his heart and lungs are normal on exam. Because of his age, a screening EKG is obtained and shown above. The EKG computer says "abnormal EKG."

Challenge: Do you do the case or cancel it for further workup?

Image shown under Fair Use.


tree said...

I think you need to check your EKG leads.

Craig Chen said...

yes!!!!! :)
Pre-Op I

I would repeat the EKG and proceed with the case. The EKG shows limb-lead reversal, signified by a net negative QRS and negative P in lead I with normal precordial R wave progression (the other thing on differential is dextrocardia, but this does not have normal precordial progression).

Sources:; ECG Interpretations Cribsheets by G. Thomas Evans.