Rhythm Nation: Case 6

EKG-4

Here is the new EKG. There is a gift card prize to the person with the most complete answer. Look at Dr. Silverberg’s website for a guide on how to answer. Good luck.

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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mritchie

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5 comments for “Rhythm Nation: Case 6

  1. Taisia
    March 13, 2013 at 2:46 pm

    Rate: 60
    Rhythm: NSR
    Axis: left axis deviation
    Intervals PR= approx 240ms (>200ms)=Prolonged PR, QRS >120ms
    Morphology: RBBB QRS>120 with RR1 in V1, LAHB= slurred S in Inferior leads; RBBB+LAHB+1st Degree AV block= Trifascicular Block
    ST segments: No elevations or depression
    T Waves: Not flipped or flattened.

  2. foster
    March 14, 2013 at 7:38 pm

    no history? i would look/ask for empty pill bottles…and have some bicarb near by.

  3. Nathan
    March 14, 2013 at 10:17 pm

    Looks like TCA overdose, as I’m sure Dave was getting to.

    There is a widened QRS, terminal R in AVR, and a deep S wave in I. All of which are classically seen in TCA overdose.

  4. mritchie
    March 15, 2013 at 3:23 pm

    I think that is a great thought. It is always important to look at the whole EKG. AVR is often overlooked. While a terminal 40 R in AVR is seen in TCA overdose it is also seen in other diseases as well. RBBB is one of those. Below is the formal definition of RBBB.

    Right Bundle Branch Block
    RSR’ in V1-2
    Broad S in I or V6
    Broad R in aVR
    TWI in V1 or V2; sometimes ST depression there too

    Keep coming with guesses and as always, credit will only be given for formal guesses in the appropriate format.

  5. Ian deSouza
    March 23, 2013 at 2:17 pm

    Someone BETTER have gotten this!!! (see ED-ICU conference last month.)

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