Case No. 67

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Case No. 67

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Chief Complaint:

Palpitations while cleaning the house

Published: Aug. 2, 2017
Case No. 67
Author: M00se
CASE SCENARIO

82 y/o male patient presents to the ED complaining about a sudden onset of palpitations while cleaning the house. Patient has a history of a TIA 2 months ago (treated) but, no other known medical history.. The patient is diaphoretic, alert and oriented X3. He is immediately hooked up to the monitor, a set of vitals, a 12 lead ECG as well as IV access is obtained. Vitals are as follows: BP: 110/80 RR: 25 Saturation: 98% HR: 200 beats/min Temp: 37 Celsius The results of the ECG are shown in the attached media (note the rate is not up to scale). After a few minutes, another set of vitals are taken with no improvement. You also notice a slight confusion when talking with the patient.

QUESTION

What should be the first step in the treatment of this patient?

Carotid Sinus Massage
Valsalva Maneuver
Adenosine 6mg
Wait and observe
IMAGES
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