THE ED PLYMOUTH
  • Home
    • About us
    • TUEC >
      • Timeline
      • Current drawings
  • Education
    • Derrifoam Blog >
      • Get involved
      • FOAM
    • Education Faculty >
      • Core Education guide
    • Core education >
      • non-accs
      • accs
    • Higher specialist education
  • Clinical
    • EM Induction
    • Guidelines

young person collapse

28/7/2015

 

by Adam Herbstritt


​38 year old female.
Out of hospital arrest. Paramedics on scene within minutes and shocked VF 3 times to ROSC.
Intubated in ED for cerebral agitation.

Whats your ECG differential for young person collapse?

Now interpret his.
Picture

Sinus 78reg, normal axis. ST elevation V1-3 with inter ventricular delay QRS 115ms.

This is consistent with Brugada syndrome.  Along with WPW, HOCM, and long QT syndrome its a 'collapse' ECG finding we should all be looking out for.  There is a high association with sudden death.   Patients have structurally normal hearts but a mutation in the cardiac sodium channel gene. Interestingly there has been reported benefit from interim sodium bicarb if repeated shocks fail to cardiovert in Brugada - perhaps working similarly to its use in sodium blocking ODs like Tricyclics.

Patients need an implanted defib. Diagnosis depends on a characteristic ECG finding AND clinical criteria. (Brugada sign in isolation is of questionable significance).

There are 3 types...but just think STe V1-3 with slight QRS widening. (images from LITFL)

Picture

The patient had a normal angio and an ICD was sited on day 3. She was discharged without neuro deficit.

Comments welcomed!


Comments are closed.

    Categories

    All
    ACCS
    Cardiology
    ENT
    Minors
    Non Tech
    Non-tech
    Orthopaedics
    Paediatric
    Radiology
    Safety
    Simulation
    Toxicology

    The Derrifoam Blog

    Welcome to the Derrifoam blog - interesting pictures, numbers, pitfalls and learning points from the last few weeks. Qualityish CPD made quick and easy.....

    Subscribe to our mailing list

    * indicates required

    Archives

    October 2022
    April 2021
    March 2021
    February 2021
    January 2021
    December 2020
    November 2020
    October 2020
    September 2020
    July 2020
    June 2020
    May 2020
    April 2020
    January 2020
    December 2019
    July 2019
    May 2019
    February 2019
    December 2018
    November 2018
    September 2018
    July 2018
    May 2018
    April 2018
    December 2017
    November 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    November 2016
    September 2016
    August 2016
    July 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    November 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    January 2015
    November 2014
    October 2014
    September 2014
    August 2014

Picture
  • Home
    • About us
    • TUEC >
      • Timeline
      • Current drawings
  • Education
    • Derrifoam Blog >
      • Get involved
      • FOAM
    • Education Faculty >
      • Core Education guide
    • Core education >
      • non-accs
      • accs
    • Higher specialist education
  • Clinical
    • EM Induction
    • Guidelines