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Just a Fever…or not?

by on January 4, 2012

Greetings all, and happy new year!

I am here to share an interesting case with you from an EMS call ran last week.  Respond with thoughts or comments on interpretation, and how you would treat this patient.  After a couple days or so, I will post a follow up with the outcome of the case and how the crew treated the patient.

This call was for a 97 year old male patient complaining of cold/flu like symptoms for several days.  Specifically he complains of fever and malaise for 5 days, with reported weakness the current day. He denies any chest pain, shortness of breath, or nausea/vomiting. He does report decreased fluid intake and skin turgor is somewhat poor.  The patient presentation is as follows:

Approximately 200lb male, CAOx4 with normal skin color, patent airway, and eupneic with BBS clear/equal.  No anxiety or obvious distress. Skin is very warm and dry with poor turgor. Regular radial pulse present.  Cap refill is normal. PERRL. No JVD, slurred speech or deficits noted. PMSx4 with equal function. ABD is soft, non-tender. A set of Vital Signs is obtained:
HR: 110
RR: 18
Sp02: 97%
BP: 118/78
Temp: 104 degrees F

The crew makes a decision to obtain a 12-lead EKG. It is shown below (Click to fully open, and my apologies for quality issues).

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From → Case File

10 Comments
  1. Byron Wanstall permalink

    ok so, sinus tach with 1st degree heart block, trigeminy and ST elevation in v1 v2 plus small voltage in limb leads? im thinking right sided myocardial injury, an inferior-anterior mi perhaps?

  2. Anonymous permalink

    What about the other leads?!…sinus tachycardia,first degree AV-block,p-mitrale,VES-probably from the right ventricle…

  3. Stefano Bruni permalink

    Given the non-specificity of symptoms I would echo the heart and control enzymes in suspected anterior infarction

  4. sinus tach with first degree block and prolonged Qt and possible U waves. V1 and V2 is concerning but I am gonna say fever with electrolyte imbalance(sodiaum potassium etc)

  5. Raed permalink

    No my friends. This is type1 Brugada ECG induced by fever. There is no acute ischemia in this case.
    Regards

  6. Igor permalink

    am I the only one to see the brugada? type 1? St elevation v1 v2 with negative T wave without definition bettwen QRS and T wave. PVC’s are normal in old people, 1st degree AVB too, but it could be also because of the brugada, a good % of brugada patient’s has it. And probably induced by fever/respiratory infection. The WPW pathways are also discovered in case fever’s like this!

  7. Mark Younger permalink

    We need to see the whole ECG. The patient has a leftward axis probably from an anterior fascicular block and a first degree AV block. If they also have a right bundle branch block, they could have trifascicular disease. Since the precordial leads are not included, we can’t tell. It is important to have a whole ECG.

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