? blunt myocardial injury

[John Holmes]

Not sure you can call this kid "stable".  Very fast rhythm with wide polymorphic complexes.  May be SVT with rate dependant aberrant conduction (+/- bypass tract)  but I'd also be concerned about polymorphic VT with possible underlying prolonged Q-Tc or cardiomyopathy. 
 
Adenosine may result in VT/VF if things go wrong but then it should be shockable.    If not game to try adenosine then I think you have to control the rate - can't wait 3 hours for cardiologist to arrive.  I might try esmolol or sotalol or maybe IV lidocaine.
 
I think I might be tempted to try some IV magnesium first before anything else.
 
Good case!
 
John
 
 
Dr John L Holmes Director Emergency Medicine TrainingAMC & OLVG, AmsterdamThe Netherlands

> To: trauma-list at trauma.org> From: jduchesn at tulane.edu> Date: Sat, 19 Apr 2008 11:56:45 +0000> Subject: Re: ? blunt myocardial injury> > None of the above. In a "stable patient" the more you know about him the better your game plan. After full vascular clinical exam and cxr,> Follow up with echo to look Ao root, chambers, effusion, contractility and EF at that fast rate.> For now I will not do anything fancy except rate control and telemetry with cardiology consult.> Good luck> Juan> CharityOne NO> Sent via BlackBerry by AT&T> > -----Original Message-----> From: joe.nemeth at mcgill.ca> > Date: Tue, 01 Apr 2008 12:35:39 > To:trauma-list at trauma.org> Subject: ? blunt myocardial injury> > > > 15 y.o male, prev. healthy...> Kicked in the chest 8 hours prior to presentation...> Feeling "funny" since...> Besides the pulse (180-220/min), all other VS normal...> Exam non-contributory...> ECG attached...> > -maybe one prior episode of "palpitations" in the past> > Treatment:> > 1) one of : CCB/BB/Dig> 2) electrical cardioversion> 3) Amio> 4) since pt. stable, wait for peds cardiology to arrive approx 2-3 > hours...("first, do no harm")> 5) none of the above> > --> trauma-list : TRAUMA.ORG> To change your settings or unsubscribe visit:> http://www.trauma.org/index.php?/community/