50 yrs old male pt admitted with alleged h/o snake bite in his left foot..on admission vitals stable. .CT 20 mnts clotted. .no cellulitis. no ptosis. ECG TAKEN. .. ASV not given. ..antibiotics and iv fluids given. ....then suddenly pt has complaints of chest tightness. .on examination pulse feeble. .BP. 60/?..profuse sweating present. ..what diagnosis. .how to manage this pt in this scenario.

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Acute MI is because of hypotension (low coronary perfusion). It seems unlikely that patient will die of ARF on second day. In fact ARF and low coronary perfusion (causing MI) are due to low blood pressure. He is expected to Die on second day due to lactic acidosis due to low tissue perfusion. IABP might have helped to maintain perfusion. Bedside echocardiography would have helped to judge LV function causing cardiogenic shock,if at all it is there. MI seems to be the result rather than the cause.

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Next day ecg. .BP Is around 90/60 with dopamine support. .but died of ARF. .I have posted this case for awareness in snake bite with MI..I think I have done whatever the best treatment available in our hospital. but I'm unable to save the patient.

True very nice case
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Snake is not poisonous. There seems to be antibiotics induced hypersensitivity or anaphylaxis. Treat with Epinephrine + corticosteroids +antihistaminics +IV fluids + oxygen

Thanks for more impt point. .inj. cefotaxime given ATD. After 1 hr only pt went for shock sir
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extremely thankful to santosh sir and all the participants. .

THIS CASE HIGHLIGHTS That D WINTERS IS STEMI equivalent

exactly sir. .I have seen 3 cases of d winter t waves sir.
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age. 45 yrs

Know .....

POSSIBLY CYTOLYTIC VENUM HAS CAUSED THIS PROBLEM TISSUE DESTRUCION BY DIGESTION & HSEMORRHAGE & HAEMOLYSIS DUE ENDOTHELIAL DAMAGE OF BLOOD VESSELS HYPOTENSION DIC MAY OCCUR TACHYCARDIA HYPOTENSION DIC TISSUE HYPOPERFUSION METABOLIC ACIDOSIS CARDIAC HYPOPERFUSION MYOCARDIAL DAMAGE BY CYTOLYTIC VENUM CAN CAUSE IHD MI ADV = AVS BLOOD TRANSFUSION ..........ANTIBIOTICS 02 INHALATION

it was a very nice case...few days back I came across a article about stress cardiomyopathy aka tokutsobu cardiomyopathy...so st elevation can be because of its..without CAD..but of course we have to exclude it by CAG and to see RMWA echo is valuable in this case..any different opinions are most welcome..regards

since pt is haemdynamicaly unstable so start with 10 to 15 vial asv to be infused in dns.within 30 minutes. rpt asv infusion until ct s .normal. bloody transfusion is also given.rpt ecg is done to evaluate the old mi. if needed treated with nitroglycerin .aspirin is not given. monitoring is done .

Thanks for ur answer sir...ASV indicated in cellulitis increased or ptosis or CT 20 MNTS NOT clotted or any bleeding. ..I think ASV not to be given only for haemodynamically unstable. ...
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