Monday, 21 December 2009

60 year old male c/o loss of balance


Lead II strip


Pre-hospital 12 lead


12 lead ECG capture in the ED


This 60 year old male patient rang for an 999 emergency ambulance... c/o loss of balance... No other symptoms... On the arrival of the ambulance crew... This 60 year old male greeted them at the door, the patient seemed to be very unsteady on is feet and leaning postural wise to the left.


On examination this patient had a positive FAST test, slight problems getting is words out, slight facial drooping on the left side, and unequal grip strength... Patient denies any aches or pains and states he just wants to go to work for is last day before he retires...


Baseline observations taken from this patient are as follows:


HR: 81 bpm
BP: 135/75
Sp02: 98% on air
Blood sugar: 7.1 mmol/l
Resps: 20
GCS - 15 / p/t fully alert and well perfused (pink)
Temp: 36.7

This patient is normally fit & well... Nil reg meds ever taken... Patient never been diagnosed with any previous conditions.

Patient denies any previous episodes of any chest pain, no N&V, skin was dry, non-sweaty, no visual problems or headache...etc... just unsteadiness on his feet, losing is balance.


What do you think about this patient's ECG's??? 




Questions:



  1. What does the ECG's show?
  2. What are the likely mechanism of this?
  3. What are the likely causes of this?
  4. What are the key issues in managing this patient?