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January 2010 EKG Case A 58 year old female is brought to the emergency department obtunded. She is tachycardic, BP 90/40 and her skin feels dry. The husband last saw her normal about 3 hours ago when he left to go to the store. He states she has a history of hypertension and depression. You obtain the following EKG. She had a normal EKG 3 months ago. What does EKG #1 show and what is your diagnosis? Rate: 130 Rhythm: sinus tachycardia with LBBB Axis: normal PR: normal ST: T inversion V6 QRS: wide complex EKG Diagnosis: sinus tachycardia with LBBB Clinical Diagnosis: tricyclic antidepressant overdose What treatment did you give this patient to get from EKG #1 to EKG #2? - intubate - bicarbonate IV - gastric lavage, especially if within first hour - IV fluids
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