A 34 year old male is brought into your ED as a priority call.
He was working at a local restaurant when he collapsed. On arrival at the scene the ambulance crew report that he was in respiratory arrest. They performed bag and mask ventilation and the patient rapidly started breathing spontaneously and became more responsive but remains very confused.
On arrival in the ED he remains confused but is obeying commands and his eyes open to voice. His chest and heart sounds are normal. His pupils are mid-sized and equally reactive to light. He has no focal neurology.
His Vital signs are:
| HR | 66 | /min | |
| BP | 184/98 | mmHg supine | |
| Temp | 37.4 | oCelsius | |
| RR | 28 | /min |
Sats 100% (FiO2 60%)
An ECG is performed:
| a. | Describe the features of the ECG | (40%) |
| b. | Outline your assessment of this patient. | (60%) |
About Peter Allely
a. Broad, deeply inverted T waves and prolonged QTc
b. (? Subarachnoid hemorrhage) Head CT. If negative, lumbar puncture.
I agree with Patrick. Widespread TWI. Prolongation of the QT (i.e. greater than R-R/2), terminal R in aVR.
Differential would have to include myocardial ischaemia and toxidrome, but in the clinical context is highly suggestive of SAH.
Certainly your bedside investigations would also incl. an ABG, BSL, Urine dipstick. Routine bloods incl. Coags, cardiac biomarkers and paracetamol levels. Non-contrast CT and an LP if imaging is equivocal and there is no contraindication.