A 45 yr male presents with vomiting 8 -10 episodes since 3 hrs intermittency, non projectile , reduces on medication, ??features of hypothermia + , no h/o chest complaints , Patient comfortably lying on , Vitals BP 124/70 Pr 82/min S/E NAD ECG attached ,, pls give ur valuable opinions



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Septal & Lateral Wall MI, Needs Trop-T & Cardiac enzymes. CBC,BSL,HBA1C, Electrolytes, Lipid profile, Echocardiogram Hospitalization in CCU, Continuous monitoring ECG. R/O CVA or Brain SOL. Management:IV fluids, Nitroglycerin, Onsansetron,O2 inhalation & continue treatment on clinical views & investigation reports.

Thanks Dr Tikeswar Ghotekar

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ECG suggests acute myocardial ischemia, No chest pain indicates silent MI as occurs in Diabetic pt Hypothermia suggests poor peripheral perfusion. As pt is lying calm and quite, which may be misleading So, To arrange for investigation TropT, blood sugar, urea, creatinine and electrolytes ,urgent ECHOCARDIOGRAM and resuscitation protocol accordingly.

Thank you sir

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St elevation in 1 avlv2v3v4 suggestive of AWMI sinus rythm mild bradycardia features of hypothermia take it as ACS in treat in icu with monitoring yes do trop t and cardiac enzymes .

Thank you sir

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This type of ST elevation in | ,avL is commonly seen as a normal variant probably Early Repolarisation variant...rest depends on the clinical presentation of patient

Check V2, V3 ST from the above ECG

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Anterolateral myocardial infarction

I agree Dr.Umesh Shinde it has silent myocardial infarction

Extensive hyper acute anterior lateral MI. Trop T must be done.

It's a case of Acute Gastroenteritis with severe Dehydration causing Hypothermia ADMIT RECORD VITALS Hrly IV Fluids NS DNS RL IV Metrogyl Ciprofloxacin Inj. Perinorm IV Slowly lnj Look for Electrolyte imbalance Na K levels ECG Shows Hypopotacimia

Appearance of significant Q wave in lead v1 AWMI

Hypothermia is a potentially dangerous drop in body temperature, usually caused by prolonged exposure to cold temperatures. The risk of cold exposure increases as the winter months arrive. But if you're exposed to cold temperatures on a spring hike or capsized on a summer sail, you can also be at risk of hypothermia. Normal body temperature averages 98.6 degrees. With hypothermia, core temperature drops below 95 degrees. In severe hypothermia, core body temperature can drop to 82 degrees or lower. Cause:-During exposure to cold temperatures, most heat loss -- up to 90% -- escapes through your skin; the rest, you exhale from your lungs. Heat loss through the skin happens primarily through radiation and speeds up when skin is exposed to wind or moisture. If cold exposure is due to being immersed in cold water, heat loss can occur 25 times faster than it would if exposed to the same air temperature. Symptoms:-Slow, shallow breathing Confusion and memory loss Drowsiness or exhaustion Slurred or mumbled speech Loss of coordination, fumbling hands, stumbling steps A slow, weak pulse In severe hypothermia, a person may be unconscious without obvious signs of breathing or a pulse Hypothermia symptoms for infants include: Cold-to-touch, bright red skin Unusually low energy Treatment:-Hypothermia is a potentially life-threatening condition that needs emergency medical attention. If medical care isn't immediately available: Remove any wet clothes, hats, gloves, shoes, and socks. Protect the person against wind, drafts, and further heat loss with warm, dry clothes and blankets. Move gently to a warm, dry shelter as soon as possible. Begin rewarming the person with extra clothing. Use warm blankets. Other helpful items for warming are: an electric blanket to the torso area and hot packs and heating pad on the torso, armpits, neck, and groin; however, these can cause burns to the skin. Use your own body heat if nothing else is available. Take the person's temperature if a thermometer is available. Offer warm liquids, but avoid alcohol and caffeine, which speed up heat loss. Don't try to give fluids to an unconscious person. Medication:- The goals of pharmacotherapy are to reduce morbidity and prevent complications. Agents in this class may inhibit adrenergic stimulation; affect potassium, calcium, and sodium channels; prolong the action potential and refractory period in myocardial tissue; and decrease atrioventricular conduction and sinus node function. They may be used when ventricular fibrillation persists despite rewarming;Amiodarone (Cordarone, Nexterone, Pacerone)

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