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M&M - Dr. Reyner

7/10/2014

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Picture
Case 1 - S/P Arrest w/ STEMI
  • STEMI  - >1 mm STE at the J point in 2 contiguous leads or greater than 2 mm STE in 2 contiguous leads isolated to leads V2-V3; reciprocal depression makes diagnosis more likely but not necessary for diagnosis. 
  • RBBB - causes = ischemia, functional, iatrogenic 
      > Definition - QRS >120 ms; RSR' pattern v1-v3, slurring of S wave in lateral leads
  • Diagnosis of STEMI in the setting of RBBB does not require special diagnostic criteria.
  • Consider RBBB as the result of an anterior MI (LAD lesion) rather than as a “benign bystander.”
  • AHA recommends PCI for patients with aFMC-to-device time system goal of 120 minutes or less and fibrinolytics for patients > 120 minutes (FMC = first medical contact).
  • Using a cutoff of 20 minutes from arrest to ROSC captures 96% of survivors and achieves a survival rate of 82%.


Case 2 - Ear Pain and Facial Palsy
  • Gradenigo’s Syndrome: Triad of otorrhea, retro-orbital pain, and CN VI palsy (diplopia).
  • Consider Gradenigo’s in patients with a cranial nerve palsy in the setting of acute or chronic otitis media.

Case 3 - Ataxia and Headache after Rollercoster Ride
  • Wallenberg Syndrome- lateral medullary syndrome- is an acute infarct involving the lateral medulla oblongata
  • It is the most common brainstem stroke
  • Patients present with vertigo, facial numbness, dysarthria, dysphagia, ataxia, and cerebellar signs
  • Consider CNS pathology in patients presenting with neurologic complaints after a roller-coaster ride
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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction