Discussion for 70 Year Old Male: Short of Breath

  This is the discussion for “70 Year Old Male: Short of Breath“. Tough case.  Lots of excellent comments and observations from our readers. Right off the bat, the patient’s presentation offered a major distraction: the recent eye surgery resulting in the old “eye patch presentation”.  Confounding the situation further was the lack of any cardiac history, and lack of chest pain.   Let’s review the 12 lead: Sinus Tach, 115 bpm. Physiologic left axis deviation. Left Bundle Branch Block.   Clearly, the moderate dyspnea and basilar crackles were red flags, as was the sinus tach at about 115 bpm.  What are we most concerned about? ACS PE Hypvolemia Infection This is not an exhaustive list to be sure, but these seemed to be the most likely concerns. While ACS was a primary concern, how about PE? I wouldn’t think it likely from cosmetic eye surgery, but stranger things have happened. What about subendocardial ischemia due to hypovolemia? Could the patient be dehydrated? He hadn’t had much to eat or drink since his surgery. How about infection? He denied recent illness, but post-surgery an infection is on the table too. Even so, when a patient with no history of respiratory disease experiences the onset of shortness of breath with crackles severe enough that he can not speak in full sentences, this is highly concerning. Throw in the family’s description of “wheezes” (no asthma/COPD history remember...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: 12 lead ecg ems-health-safety ems-topics patient-management Training training-development 12-Lead ECG appropriate discordance appropriate T-wave discordance broad QRS tachycardia David Baumrind EMS 12-Lead ems12lead.com left bund Source Type: research