A 72-year-old man with a history of advanced dementia is brought from home by paramedics for approximately one week of cough followed by two days of worsening shortness of breath and now a syncopal episode. All history is obtained from family and medics as the patient is unable to provide any history. An albuterol treatment was given en route for wheezing.
Exam: Vital signs are normal except for a pulse of 198. The patient is somewhat lethargic and does not answer questions. His lungs have bilateral ronchi without rales or wheezing. There is mild symmetric pitting leg edema, which the family says is chronic and at baseline.
Initial differential diagnosis:
- Electrolyte abnormality
- Pulmonary Embolism
- Acute Coronary Syndrome
EKG read (see image on the right):
- Wide QRS tachycardia (rate 199)
- Right bundle branch block
Do you agree with the read?
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