Medchrome » Emergency cases http://medchrome.com Online Medical Magazine Wed, 25 Jan 2012 03:35:04 +0000 en hourly 1 http://wordpress.org/?v=3.3.1 Case Review : Acute ST Elevation MI http://medchrome.com/medical-cases/case-review-acute-st-elevation-mi/ http://medchrome.com/medical-cases/case-review-acute-st-elevation-mi/#comments Thu, 06 Jan 2011 14:55:09 +0000 Merry Shrestha http://medchrome.com/?p=2180 A 46 years Male from Nuwakot came to ER with complains of Epigastric  and retrosternal pain for 16 hours. The pain was constricting type , continuous, radiating to left arm and neck, and not relieved in any position. It was associated with Shortness of breath. He had 3 episodes of Vomiting and sweating. He also complains of palpitation. Headache +, LOC followed the event and he was rushed to ER. Bowel/Bladder habits were Normal.

He had no history of chest pain before but he is a smoker, 9-10 sticks per day for past 30 years. He occasionally consumed alcohol.

He doesn’t give history of HTN, or Diabetes Mellitus.

On Examination at ER:

  • GC-  patient conscious but in agony.
  • Vitals- Blood pressure- 100/80 mmHg, Pulse= 64/minute, RR=32/min , Temperature=Normal
  • Cardinal signs- JVP- raised
  1. Chest- Bilateral Normal Vesicular Breath Sound, No added sounds
  2. CVS- S1 and S2 Normal, No mumur
  3. P/A-  soft, non-tender, no organomegaly
  • ECG showed- ST-T changes specific of Antero-lateral Myocardial Infarction. Q waves.
STEMI st elevation ecg 300x129 Case Review : Acute ST Elevation MI

ST elevation in chest leads

heart attack ecg 300x149 Case Review : Acute ST Elevation MI

  • Total Count- 11,700 with N-87 and L-10, Hemoglobin=13.4 g%
  • Cardiac Enzymes= CPK MB= 109 U/L after 4 hours CPKMB=421U/L, Troponin I was positive.

Diagnosis- Anterolateral MI

Immediate Management-

  1. Oxygen
  2. Aspirin
  3. Clopidogrel
  4. Inj Morphine
  5. LMW Heparin
  6. Isosorbide dinitrate
  7. Isosorbide Mononitrate
  8. Alprazolam
  9. Cremaffin

Patient could not be Thrombolysed because it was past recommended time and Q waves in ECG were seen by arrival.

CCU course-

day1 -Patient developed hypotension . ECG showed Inferior wall extension.Inotropes were started.

day 2-Couplets were seen, Hr-120 beats/min and was controlled by beta-blocker Metoprolol low dose

day 3- Inotropes were tapered gradually. Patient’s condition improved.

ECHO done.

Planned for Coronary Angiography. Possible CABG.

Case Review : Acute ST Elevation MI]]> http://medchrome.com/medical-cases/case-review-acute-st-elevation-mi/feed/ 0 Medical Case Review: Tetany http://medchrome.com/medical-cases/emergency-cases/medical-case-review-tetany/ http://medchrome.com/medical-cases/emergency-cases/medical-case-review-tetany/#comments Thu, 24 Dec 2009 16:08:57 +0000 Administrator http://medchrome.com/?p=555 A 23 year female presented to Emergency with sudden stiffness of hand muscles, tingling sensation in the face with difficulty in opening the jaws and weakness of muscles of thighs for about 2-3 hours.

She had no other complains.

No similar History in tha past.

LMP was 3 months back.

On examination:

GC- Patient looked anxious

PILCyClOD- Pallor +

  • Chest -NAD
  • CVS-s1 s2 m0
  • P/A- soft, non tender
  • Tap on facial nreve= tingling  and twitching ( ? Chvostek)
  • Hands:
    tetany Medical Case Review: Tetany

    Accoucher's hand

    Knee Jerks: slightly exaggerated.

Our Differentials were:

  • 1. Tetany
  • 2. Conversion Disorder

Lab Reports revealed:

Hb: 8.3%

TC,DC,Urine R/m/e,  all within normal range

Urine pregnancy test- positive

Na+ 132 mEQ/l

Ca++ 6.1 mEQ/l

WHAT COULD BE THE DIAGNOSIS?

Is it likely to see features of tetany at 6.1 meq Ca++?

Medical Case Review: Tetany]]> http://medchrome.com/medical-cases/emergency-cases/medical-case-review-tetany/feed/ 2