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Antidotes Used In Toxicology

Orthopedics

 A 62 year old male presents as a medical notification for cough, severe shortness of breath and chest pain.  The patient has no past medical history and takes no medications. The family states “he smokes too much” for many years. Lately he can’t walk very far without getting winded and has been increasingly using his daughter’s asthma pump.

What does the EKG show and what is your diagnosis?

Rate:    140-150

Rhythm:  irregular

Axis:    near zero

P-waves and PR: multiple morphologies with peaked p-waves > 2.5mm in leads II, III, variable P-P intervals

QRS:   narrow complex, borderline LVH

ST:    depressed in II, III, aVF

EKG diagnosis: Multifocal Atrial Tachycardia with associated p-pulmonale

• Clinical diagnosis: COPD exacerbation with long standing disease and chest pain r/o MI
• Practical points: - varying p-wave morphology
• -markedly irregular P-P intervals
• -causes include diseases that decrease oxygen in blood such as:
• COPD, pneumonia, CHF, lung cancer, PE
• -other causes include coronary artery disease, theophylline overdose, diabetes, and sepsis
• -Treat the underlying condition, give oxygen

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