Spot Diagnosis!

Have a look at these three short videos…  Taken on a recent Sydney HEMS mission.

Can you guess the diagnosis??

NB. Art line trace is in yellow, SaO2 in blue. 

Post your answers below. First correct answer wins a crate of beer (maybe)!

 

 

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10 Responses to Spot Diagnosis!

  1. gasclass says:

    Pericardial tamponade.

    • Kathryn says:

      Agree. Pulsus paradoxus happening from tamponade. Maybe caused from pericarditis with the ST elevation?

  2. Mark Flett says:

    STEMI (can’t make out which lead is shown but looks like III from QRS axis)
    ventilated patient with pulsus alternans
    My guess is aortic root dissection with RCA occlusion and pericardial tamponade?

  3. @Paramedidad says:

    Pulsus paradoxus. Cardiac tamponade would be my guess

  4. Luke Ashford says:

    Is it STEMI?

  5. Ram says:

    Pericardial tamponade causing PEA

  6. Matt CW says:

    No idea – I would have put that Sa02 down to interference.

  7. Edward Burns says:

    Thanks to everyone that commented.
    This patient did indeed have pericardial tamponade!
    Kudos to those that spotted the pulsus paradoxus on the arterial line tracing (systolic BPs varying from 50 to 100mmHg across the respiratory cycle).
    In this case, the cause was a misplaced transvenous pacing wire causing RV perforation with acute haemopericardium.
    The pacer wire remains in situ and the patient is VVI paced at 80bpm, which explains the ST elevation seen on the ECG tracing.
    The patient was retrieved by helicopter for emergent sternotomy after failed pericardiocentesis.
    Vibrations in the aircraft caused interference with the SaO2 probe, hence the bizarre (almost Torsades-like) SaO2 tracing.

  8. Pingback: The LITFL Review 142 - LITFL

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