You can check out his venous blood gas over at Emergucate's Lab Case 28 here.
Check out the comments on our original post here.
|Click to enlarge|
- ~110 bpm
- Sinus rhythm
- PR - Normal (~120ms)
- QRS - Normal (100ms)
- QT - 440ms (QTc Bazette 550-600 ms)
- ST Elevation leads aVR, aVL and V1
- ST Depression leads II, III, aVF, V4-6
- QTc Prolongation and ST segment changes in the setting of significant acid-base disturbance
- Severe alkalaemia
The patient's additional biochemistry revealed a primary hypochloraemic metabolic alkalaemia with significant acute renal failure due to recurrent vomiting.
He received titrated benzodiazepines for agitation and following careful re-hydration and electrolyte monitoring the patient's ECGs normalised.
Subsequent upper GI endoscopy revealed an inflammatory gastric outlet obstruction as the cause of his recurrent vomiting.
References / Further Reading
Life in the Fast Lane
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.