Concluded Case

Patient come with semiconscious stage Epigastric pain RBS -522 Known case -CKD,CAD post ptca,DM, Parkinson's Pls suggest

2 Likes

LikeAnswersShare
Concluded answer

ECG shows complete heart block with junctional rhythm and rate of 42 / min It need to be treated by PaceMaker insertion X ray chest shows cardiomegaly, subclavian line is in situ which needs to be withdrawn a little, as tip of catheter is seen reaching right ventricle ABG shows severe metabolic acidosis which is not compensated by respiratory alkalosis, there is high anion gap which is suggestive if Superadded ketoacidosis Adv Pacemaker insertion Insulin infusion to bring blood sugar to normal and to treat ketoacidosis Hydration Treatment of underlying sepsis This patient may need ventilatory support

All Answers

Ecg AV dissociation nodal rythm CHB Xray chest cardiomegaly ABG respiratory alkalosis/Metabolic ketoacidosis Uncontrolled diabetes RBS 522 Pt appears to be in hyperglycemic coma Needs to maintain ventilation intubate and give assisted respiration Correct metabolic acidosis by inj sodium bicarbonate 7.5%100ml iv push Correct hyponatremia inj NS Broadspectrum antibiotics inj Ceftriaxozone Inj dexamethasone Adv MRI brain

Thanx dr Sandeep Ghodekar
0

ECG shows complete heart block with junctional rhythm and rate of 42 / min It need to be treated by PaceMaker insertion X ray chest shows cardiomegaly, subclavian line is in situ which needs to be withdrawn a little, as tip of catheter is seen reaching right ventricle ABG shows severe metabolic acidosis which is not compensated by respiratory alkalosis, there is high anion gap which is suggestive if Superadded ketoacidosis Adv Pacemaker insertion Insulin infusion to bring blood sugar to normal and to treat ketoacidosis Hydration Treatment of underlying sepsis This patient may need ventilatory support

Acidosis affects the mechanical and electrical activity of heart but comparatively little is known about its effects on the function of the atrio-ventricular node (AVN). Lowered pH can result in detrimental consequences that include a reduction in cardiac contractility and development of cellular triggers for arrhythmias . This contribute to arrhythmogenesis, in particular brady-arrhythmias and heart block in conditions in which the heart is exposed to acidosis, such as myocardial ischemia. S.Elecrolyte to be best taken care of in view of Hyponatremia.. Immediate PACING is suggested by interventional cardiologist. Glycemic index to be controlled. PROGNOSIS IS VERY POOR

Complete Heart Block Needs urgent Pacemaker . Xray chest COPD, emphysema PAH Cardiomegaly CV lines seen ABG Severe Metabolic acidosis ,partially corrected by respiratory alkalosis ,DKA Hypocarbia, anion gap , hyponatremia, hyperkalemia Suggest IV Insulin, IV NS, bicarb, supportive measures Watch renal functions CT brain to rule out CVA .

Ecg For rhythm longer rhythm strip needed Lab Metabolic Acidosis with Hyperkalemia,,, rest of Lytes are decreased X-ray Cardiomegaly with Widening of Angle of carina Need Echo

Prolonged PR, ? Ventricular rhythm needs long leads rhythm. See for hyperkalemia.

CHB with AV dissociation with ABG shows Respiratory Acidosis with Hyperkalemia with Pacemaker inserted in xray of chest please go for KFT function & urine for ketone for Diabetic Acidosis Please tell vitals with age of patient & tell stage of CKD for Prognosis IN THIS type of patient heart rate will be bradycardia

3rd degree AV block PR interval changes

Sinus bradycardia

CHB I think Tom placed by cvp line