EKG – 4 – Atrial Enlargement

A 17 yr old female presents to the HUM ED with acute onset left sided weakness approximately 6 hours prior to arrival.  On exam, she was found to have a left sided facial droop, left arm and left leg weakness (able to walk but does so with significant limp). Her overall examination was consistent with an acute stroke.

An EKG was performed and is attached.  What does this EKG suggest and what other bedside test should it prompt you to perform?


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Ultrasound – 4 – Hydronephrosis

This ultrasound performed by R3 Family Medicine Resident Dr. DM of HSN demonstrates SEVERE hydronephrosis.  This patient came through clinic and had minimal to no pain suggesting this was likely a chronic process.  When estimating the degree of hydronephrosis, a general estimate based on the appearance of the renal pelvis is sufficient – there is no such thing as “40% hydronephrosis” or other exact numbers.  A patient can have “mild” or “moderate” or “mild to moderate” or in the case of our patient, “severe” hydronephrosis.

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EKG – 3 – Complete Heart Block

A woman presents to Mirebalais with shortness of breath and generalized weakness.  On presentation, patient is dyspneic with bilateral crackles and lower extremity edema.

Vitals per triage sheet:  BP 151/118, FC 155, FR 48, O2 sat 98% on nonrebreather mask, Temp 35.8C

I have also attached a short video of her monitored rhythm.

WHAT DOES HER EKG SHOW? And what is usual about her monitored rhythm and vitals obtained at triage?

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EKG – 2 – Atrial Fibrillation with Rapid Ventricular Response

72 year old female presents to HUM with shortness of breath and increasing lower extremity edema over the last month.

Vitals: SBP 160s, HR 170s, RR 26, O2 sat 94 % on RA

On exam, patient tachypneic, able to speak in short sentences, had irregular heart rate, crackles through lungs with decreased breath sounds bilaterally, distended abdomen with marked bilateral lower extremity edema.

WHAT DOES HER EKG SHOW? (Below is a short video of her monitored rhythm.)

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