Friday, 20 August 2010

79 year old female CC: Unresponsive

Here's a very interesting and unusual case submitted by a long-time reader of the Prehospital 12-Lead ECG blog named Christopher Linke (aka SoCalMedic).

I'll warn you up front that the patient insisted on being transported to a hospital without specialty services so we have no information about diagnostic testing that might confirm the diagnosis.

EMS is called to the scene of an "unresponsive" patient.

Upon arrival, paramedics find a 79 year old female with no complaints. The patient's family states that the patient's eyes rolled back into her head and she became unresponsive.

More disturbingly, the family states that she was not breathing and did not have a pulse prior to EMS arrival. CPR was performed.

At the time of EMS evaluation the patient is oriented to person and place but not time or event.

Vital signs:

Resp: 26
Pulse: 112
BP: 125/77
SpO2: 84 RA

Patient is resting in her right side.

Skin is pink, moist, and hot to the touch with no cyanosis.

No accessory muscle usage. No JVD, tracheal deviation or pitting edema.

The family states that the patient was diagnosed with ventricular tachycardia within the past week for which she takes amiodarone.

No known drug allergies.

Patient was placed on the cardiac monitor (this rhythm strip was captured later in the call).

A 12-lead ECG was captured.

Serial ECGs were performed en route to the hospital.

Do you see anything unusual that is cause for concern?