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85 year old female altered mental status

by on August 31, 2011

Arrived on scene of local nursing home. Staff escorts EMS to patient room where a 85 year old female is laying in bed moaning and incontinent with feces. She would not respond to EMS when she was talked to but was able to localize pain upon painful stimuli. Exam revealed an acutely ill patient with pale cold clammy skin. Radial pulses were faint upon palpation. Pupils were equal 5mm and reactive. Staff stated pt had history of diabetes, high blood pressure and dementia but usually is able to walk around and carry on some conversations. They stated that the patient also has a chronic history of UTI’s. No fever noted.

v/s taken
BP 80/Palp
HR 72
Respiration 14 with moaning
BGL 174mg/dl
only medication the staff is able confirm she takes is insulin and Metformin

Heart monitor applied

12 lead obtained

Staff can not give any other information.

What do you think is going on with this patient and what is your treatment?

From → Case File, Education

  1. Looks like a sinus rhythm w/ LBBB (maybe incomplete LBBB due to its “look”). Inappropriately concordant ST-E II/aVF/V5-V6, excessively discordant ST-E III. Excessively discordant ST-D I/aVL. Inferior MI in the face of LBBB.

    Now that I’m staring at it more, it really doesn’t look like typical LBBB, looks more like an evolving inferior MI with some QRS widening associated with the same.

    Either way STEMI!

    Check DNR status, IVs, right sided 12-Lead, early notification, let the hospital know her age/DNR status. They may elect to manage medically given her advanced age.

  2. sirens0ng permalink

    Left BBB and ST elevation, STEMI!! I agree with the above post, due to advanced age, check resuscitation status and medically manage.

    Fluid resuscitation, aspirin and pain relief, early notification

  3. looks like STEMI( II,III,aVF),LBBB 100 %
    Tratment as STEMI,,,Aspirin,Heparin,Clopidogrel,Morphin and O2
    Old patient ??? Catheter???

  4. Anonymous permalink

    This is an Acute Change…. This patient does have a LBBB but the ST changes are Obvious and need to be treated as such

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