A 65 year old woman is brought to the emergency department following a collapse at home. She is pale with a BP of 75 mmHg (systolic), respiratory rate of 25/minute, a GCS of 13/15 and an SaO2 of 92% on 6 litres/minute of oxygen. An ECG is performed. The ECG shows a bizarre broad complex rhythm at about 70 bpm with non capturing dual pacemaker spikes.
Question
| a. | Describe and interpret her ECG | (50%) |
| b. | Outline your initial management priorities for this woman. | (50%) |
Answer
FACEM VAQ Exam 2005.1 – Question 6
- Overall pass rate for this question was 37 / 44 (84.1%).
- Examiners felt this VAQ tested fundamental emergency medicine knowledge and skills. It was essential that the description include hyperkalemia as a possible explanation for the broad complex rhythm.
- Stronger answers noted the presence of the pacing spikes though this was not considered essential to pass.
- It was expected that other possible explanations such as ischaemia and drug toxicity would be considered.
- Management needed to include full resuscitation area supportive care but had to focus on urgent management of the presumed hyperkalaemia as well as volume loading, maintenance of oxygenation and probable need for chronotropes/inotropes.
About Mike Cadogan
