Sick person by LEO


Forum Asst. Chief
Oh...forgot the very common pericardial effusion that can lead to tamponade , but not necessarily. Hematoma around the aortic root can contribute to impaired coronary flow in the absence of the dissection involving the coronaries directly.

Just did one of these on Thursday night, coincidentally....
And I guess theoretically an intramural hematoma at the root could also effect the conduction system directly leading to an intraventricular conduction delay.


Forum Deputy Chief
Years ago (probably 13 or 14); I asked a cardiologist about what to call a rhythm that a patient had that we brought in to the ED, that he was hanging out in (he was working in the cath lab there). He looked at the strips, and 12 leads, asked about other VS, etc. Asked what I thought and asked what the ED doc (my Medical Director) thought. (Pt CC was short of breath)
Then told us both that we were crazy that we couldn't diagnose the easiest rhythm in the world. He asked to see my run report that I was still writing up: and wrote on it: "This Cardiac Rhythm is F***ed up beyond all recognition", and handed my run report back. I read it, told him thanks now I had to do a entirely new report. He took it back and printed his name after it, with all the letters behind it and signed it, and gave it to the Medical Director to do the same on it.
He then told us that some patients just have a screwed up cardiac rhythm that you can't diagnose. 4 hours later I was back and asked the medical director if they had any more info on the patient and he said all the blood work came back normal, and they were going to keep monitoring him and release him the next day if nothing was found.

Doc called me the next day, and they released him. nothing cardiac found, new onset of asthma.

Supervisor had a cow when he read my run report; took it to the medical director, who chewed him out for not reading the 2 doctors who signed off on the cardiac diagnosis.