Scenario
A 46 year old man is brought to your emergency department by ambulance following an overdose of unknown medications. He has had a brief generalized seizure en route.
On arrival his observations are:
Question
a. Describe and interpret his ECG (50%) a. Outline your treatment (50%)
Answer
FACEM VAQ Exam 2011.1 – Question 7
- The overall pass rate for this question was 68/82 (82.9%)
- Pass Criteria
- Part A
- Rate, Axis, Rhythm, R Prime AVR ,
- Interpretation – consistent with Na Channel Blockade
- also that QRS upper limit or slightly prolonged,
- QT almost half the RR along with examples gave extra marks
- Part B
- Mx in resus area, treatment with NaHCo3 and the doses,
- Fluid Mx for hypotension and Benzodiazepines for seizures.
- Use of RSI to assist is accepted but was felt that in this Stem was secondary to above
- Features of unsuccessful answers
- Lack of detail & precision or systematic approach to part A
- Inadequate management – focus was NaHCo3 is the antidote and 1st line treatment.
- No titration or endpoints – to pH 7.55 & QRS , and no detail in doses or utalising cardioversion in Mx
About Mike Cadogan
How would you describe the rhyth? An idioventricular? It’s irregular but has p waves that are not in association with qrs.
Is it just AF? If so was that a requirement for the answer?