Ahmed

ماشي على مهله..كل الخُطى ألحان | Internal Medicine Resident

[Ahmed @iDa7med_]

But always internal medicine are investigator

Has to think wide , gathering informations from hx , ex , ecg ,labs and imaging

Peristant tachycardia and this ecg was the only Hint in addition to recent long flight

So we orderd D dimer came positive
CT confimed Extensive PE

[Ahmed @iDa7med_]

28 years old presnted from airport with seizure , admitted as case of status epilepticus and aspiration pneumonia required High flow O2

This is his ECG :

[Ahmed @iDa7med_]

Sinus tachy
RV strain pattern :

- S1Q3T3
- T wave inversion in Rt precordial leads
- ⁠+ve kosuge sign ( T wave inversion in III and V1 )
- Clockwise Rotation of R wave suggest RV Diltation ( R wave in v1-v3 more than the the R wave in v5-v6 normally )

CTPA > Confirmed PE

[Ahmed @iDa7med_]

For this patint wells score was < 2
CXR was very bad explaining the patint desaturation

Difficult to diagnose PE when you have sever pneumonia

[Ahmed @iDa7med_]

@ecgandrhythmRoe Fasciular VT most probaply ( LPFVT )

[Ahmed @iDa7med_]

@AMigelheva @smithECGBlog @EM_RESUS 1st degree AVB
LBBB
2nd ecg > Positive sgarbossa

[Ahmed @iDa7med_]

@AMigelheva - South Africa flag sign = High Lateral STEMI
- 1st degree AVB
- PJCs

[Ahmed @iDa7med_]

@Ahmedata7777 Actually this was case of septic shock , pt was intubated and sedated
No cardiac complain before , troponin was mildely positive
There is STE in avR and STD in v5 and v6
Could be demand ischemia 2ry to sepsis in pt with CHD espeicaly left main or triple vessels disease

[Ahmed @iDa7med_]

@EngFaris1 كان كرت وانحرق مع الحراقه
الصوره فقط تكفي
تقدر تشوفك احلامك المستحيله في صوره :

[النادي الأهلي السعودي @ALAHLI_FC]

القارة الصفراء بكبرها قلبناها أخضر 💚
معقولة نسلّم السوبر السعودي للأصفر؟ ✋

#الأهلي_بطل_السوبر

[النادي الأهلي السعودي @ALAHLI_FC]

من مصلحة الكرة السعودية.. الأهلي ياخذ السوبر ويرتاح الجميع 🏆💪

#الأهلي_بطل_السوبر

[Ahmed @iDa7med_]

@ecgandrhythmRoe saddleback shaped ST elevation
Brugada type 2

[Ahmed @iDa7med_]

حدثني عني شعور ال euphoria بعد ال intubation وتصير حالته من حرجه الى مستقره

شعور عظيم جداً

2nd suscessful rapid intubation 🦾

[Ahmed @iDa7med_]

@EcgsOnly AF with pre-excitation ( Left sided WBW )

[Ahmed @iDa7med_]

@IhabFathiSulima ECG showing RV strain pattern ( S1Q3T3 , kosuge sign , TWI in inferior and Rt precordial leads , clockwise rotation of R wave in precordial leads and perisrtant S wave due to RV dailation )

CT > filling defect

Acute massive PE

[Ahmed @iDa7med_]

@ecgandrhythmRoe Ashman beat

[Ahmed @iDa7med_]

@ecgandrhythmRoe Focal atrial tachycardia
The ectopic mostly in the lower atrium

[النادي الأهلي السعودي @ALAHLI_FC]

نحـن أبطـال أكبـر قـارات العالـم 🗺️
أبطال آسيا يتمنون لكم «Weekend» نخبــوي 🌟💚

#أبطال_قارة_آسيا 🏆

[Ahmed @iDa7med_]

فرحة جمهور الأهلي فرحة وطن
السيفين والنخله بشعاره ماهي عبث 💚