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%)

ECG post collapse

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  1. Patrick says

    a. Broad, deeply inverted T waves and prolonged QTc

    b. (? Subarachnoid hemorrhage) Head CT. If negative, lumbar puncture.

  2. Ben says

    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.

  3. Dr.Hameed Chaudhari,Latur ,Maharashtra INDIA 413512 Cell no 9422468200 says

    This patient may have an episode of VT.The T wave changes can be a memory sign.Considering the age of this patient, we have to think of RVOT or LVOT. SAH is least possiblity as this pt has regained consciousness.
    I am ready to discuss in the depth.My email laturcritical@gmail.com& cell no 9422468200

    Dr.Hameed Chaudhari MD (Med)
    Latur Critical Care Center
    Gandhi Chowk ,Latur 413512