Case Study I


Mr. G. is a 30 year old male. He has a history of paroxysmal atrial dysrhythmias and has been placed on quinidine for rhythm control. He has not had an episode in about 6 months and is considered to be stable on this medication.

Mr. G. is independent, lives alone, and holds a high level position with a local software company. Recently, he came to the ED with complaints of shortness of breath, dizziness, and intermittent "palpitations".

Physical Assessment:

Neuro: AAO x 3, follows commands, moves all extremities equally. Complains of intermittent dizziness.
Pulmonary: Respirations rapid, lungs clear in all lobes.
GI: Normal bowel sounds. Complains of nausea.
GU: Normal
CV: Pulse rapid and irregular, nailbeds pink, peripheral pulses present, but weak. Complains of intermittent chest pain and palpitations.
Vitals: HR- 150 and irregular, Respiratory rate 28, BP 102/56, Temp. 98 F, SaO2 96

History:
Mr. G states that he is just recovering from a serious episode of the flu. He has experienced diarrhea and vomiting for several days. He began feeling better and resumed his medications and went back to work.
Medications:
Quinidine 400 mg, 3xday
Vitamins
ASA 80mg/day
Diagnostic studies:
CXR: Normal
Labs: Na 135, K 3.2, BUN 27, Creat. 1.4, FBS 100
EKG rhythm strip:


Questions: (IMPORTANT! See instructions below*)

 

1. Identify the dysrhythmia.
Atrial fibrillation
PSVT
Torsade de Pointes
3rd Degree Heart Block
2. What could have caused the above dysrhythmia?
Food poisoning
Hypokalemia
Hypercalcemia
Stopping his quinidine
3. What are the treatments for this dysrhythmia?
IV KCl to correct deficiency
IV lidocaine to stop the dysrhythmia
CPR
IV procainamide
4. What is the mechanism that starts this dysrhythmia?
Prolonged PR internal
Shortened QRS
Prolonged QT
Elevated ST segment

5. What is the prognosis for Mr. G?
Good, once his hypokalemia is corrected.
Poor, this is a lethal dysrhythmia
Good, after he has an ablative procedure
Poor, his flu weakened him too much to recover

 


The basic dysrhythmia course that is recommended as background for this Cardiac Case Studies course is the RnCeus.com course:

EKG Strip Indentification and Evaluation


*IMPORTANT!

Please write down and save your answers to the above questions. The questions will be repeated on the "Exam and Evaluation", but the scenarios and strips will not be repeated.


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