SDiver- Are you going to post the answer to this one? Will there be prizes like the last time? I'm willing to give BrushOkie the nipple ring I got from the last one.

BO - It'll look good on ya and the chicks think it's hot! :D

There you go, bringing up ole snaggletooth again.

Can't get her off your mind, huh? What's been seen can't be unseen.:D

K OD? :munchin :D

It's funny you should mention this Trap. It's still being discussed over on my other board. Some of the replies have been, shall we say .... interesting. Some of the strip interpretations have ranged from A-flutter, to SVT, but the majority of them are saying A-fib c RVR. (Sorry Brush, you're the only one reading a 2nd degree block.)

But yes, as I said above, the majority of the interpretations are A-fib c RVR.
Treatment would be,O2 4L, IV NS, fluid bolus 250cc to get B/P up (and that might bring back rate to sinus), if not look at cardioversion.

I'll let ya know what's determined once it's posted.

Oh look, a late entry. :p

SooooOOOOOoooooo Hyperkalemia. Part of the "H's and T's" protocol .....
http://www.rcpals.com/downloads/oct4...CLSandPALS.htm

..... anyone else seeing peaked T's ????

and go .......

Hey, old SF medic, usually stay out of these, my memory is not that good anymore. :D

A little Freudian slip there LR ??? ;) :p

The T-waves in this patient are highly irregular. May be fused P waves or U waves or both. Definitely not hyperkalemia. May be hypokalemia. Has the patient been having diarrhea? On diuretics?

May also be fused P wave and now were back to BrushOkie's heart block (probably Stage 1).

What are the chances of both hypokalemic and stage 1 heart block?

Will IV KCL (bolus, 1100 mg) be differentiating? If so I would monitor the T waves to see if a normal T wave appears. If not then we may be dealing with heart block and IV lidocaine (50 mg IV bolus) would be indicated.

I am still leaning more towards AF with hypokalemia.

Did you see Foxglove in her garden? :D

Well, they posted a Dx today .....

She must've had an underlying condition of HTN, because her MAP (Mean Arterial Pressure) wasn't below 65 .... (although, <65 is what we use to call a Sepsis alert.) .... so her lactate must have been out of wack.

MAP formula ..... Systolic X's 2 plus diastolic divided by 3

86(2) + 60 / 3 .... 172+60 / 3 = 77.3 MAP

Trap .... Your prize, along with everyone else's is ...... Greater Knowledge and Understanding. (looks like you're stuck with that nipple ring) :D

Thanks for this one. Very interesting. And, yes I did learn a few things on this one too.

One question: If she was in septic shock wouldn't she have presented with fever?

Brush Okie, I know you really wanted my nipple ring. Maybe next go around? :D

I do believe it was the nipple ring that caused the underlying sepsis.

Doom on you whosoever reuses a nipple ring.

Ooops :eek: