1

A 68 year old man reports that he has felt 'dizzy' for the last day or two. He denies chest pain but he does get 'winded really easily' for the same amount of time. Otherwise he feels well and the review of systems is universally negative. He has recently been told that he has glaucoma and hypertension and takes 'those blue and white pills', eye drops, and aspirin. He has no allergies.

Vitals: P 32, bp 84/44 RR 18 T 36.6 Pox 100% on room air. Your exam suggests a regular bradycardia, thready distal pulses but is otherwise normal.

You are handed this EKG. (Note, the EKG is much clearer if the window is full screen.)

What do you want to do???

Email Gradydoc@gmail.com with your ideas, questions, and thoughts on this case....

2

2) An 18 year old woman comes into the ED. She's been to three other ED's in the last week with the same concerns. She has had her fourth episode of sudden onset severe anxiety. She felt "...like I was going to die". Each episode was associated with a feeling of "...breathlessness". On further questioning, the episodes are associated with bilateral "...hand tingling". She denies any chest pain or other obvious associated symptoms. She also has no medical history or family history. She takes no meds and has no allergies.

Vitals: P150 Regular bp 108/56 RR 26 T 37.8 Pox 95% on room air. Your patient is clearly anxious and tachypneic. She is mildly obese. Her exam is otherwise normal.

Her EKG is handed to you. (Note, the EKG is much clearer if the window is full screen.)

What do you want to do???