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Department of Emergency Medicine, Harvard Medical School, Boston, MassachusettsDepartment of Emergency Medicine, Massachusetts General Hospital, Boston, MassachusettsDepartment of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
Department of Emergency Medicine, Harvard Medical School, Boston, MassachusettsDepartment of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
Department of Emergency Medicine, Harvard Medical School, Boston, MassachusettsDepartment of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
Reprint Address: Susan R. Wilcox, md, Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
Affiliations
Department of Emergency Medicine, Harvard Medical School, Boston, MassachusettsDepartment of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
Dr. Todd Jaffe: This is the case of a 49-year-old man who presented to the Emergency Department (ED)
with unresponsiveness. The patient had a history of hyperlipidemia on rosuvastatin
40 mg daily but was healthy prior to the day of presentation. Per the patient's son,
the patient had two glasses of wine with dinner the previous night and was otherwise
in his usual state of health prior to going to sleep. He was last seen well at 8:00
pm. The following day, his son heard a loud thud from his father's bedroom at 12:45
pm. He entered the room to find his father on the floor, unable to move, and he immediately
called 911. On Emergency Medical Services (EMS) arrival to the scene, they found the
patient on the floor intermittently blinking, but not moving his extremities. Finger
stick blood glucose was 107 mg/dL. EMS placed a cervical collar at the scene and transported
the patient to the hospital. A 12-lead electrocardiogram (ECG) obtained in the ambulance
demonstrated a sinus rhythm at a rate of 92 beats/min with evidence of a right bundle
branch block, 3-mm ST depressions in leads V4–V6, and 5-mm T-wave inversions in leads
V1 and V2 (Figure 1).
Figure 1Electrocardiogram demonstrating significant ST changes.
Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.
