Third-degree AV block the case of syncope in the ambulance practice: Case report

INTRODUCTION: syncope is defined like a transitory loss of consciousness and postural muscles tone, limited in its duration and with spontaneous recovery. Pathophysiological mechanism of syncope involve discontinuance of cerebral circulation for the 3-5 seconds. Possible etiology factors are numerous, among them are heart diseases, specially rhythm disorders. Initial treatment of these patients include evaluation of the state of consciousness, physical examination, measurement of blood pressure and blood glucose level, ECG and treatment based on the etiology of syncope. The aim of this presentation is to point the of cardiac conduction system disorder, 3rd degree heart block like a cause of syncope and to show, based on the guidebook, the treatment of the patients, up to the hospital. MATERIALS AND METHODS: comparation of the 2 patients with syncope accompanied with ECG markers of cardiac conduction disorder, more specific 3rd degree AV block. RESULTS: pointed toward importance of elimination of etiology factors of syncope, recognition of the heart disease like a cause of syncope and initial treatment of these patients. In the first case, ambulance staff intervene in the patient with a chest (retrosternal) pain, fatigue which ended with he loss of consciousness while he was sitting. Physical examination showed that patient had stable vital signs and ECG was showing the 3rd degree AV block with RBBB (right bundle branch block) and ischemia of the front myocard wall. After being treated with i.v. Atropine, patient restore a sinus rhythm. The second patient had a 3 episodes of loss of consciousness before he reached the hospital. Initial ECG showed synus rhythm, qR in III outlet and aVF, negative (reverse) T in III outlet and reduced R from V4-V6. Third episode of syncope was at the very entrance of the IR. Patient had compromised peripheral perfusion with cyanosis, but respiratory satisfied. CPR started. He gain consciousness after 20 sec. After few hours of monitoring, Dg of intermittent 3rd AV bloch was established. CONCLUSION: fast recognition and adequate treatment of both patients in the prehospital service which gave the conditions for the final treatment with a permanent pacemaker in The KCS pacemaker center

Unusual presentations of urgent thoracoabdominal pain

Introduction: Vascular emergencies in the abdomen are not common, but they are significant due to high mortality, the need for urgent diagnosis and immediate, most often operative treatment. Thromboembolic disorders lead to ischemia and infarction of the affected intra-abdominal organs, while abdominal aortic aneurysm rupture and aortic dissection, as one of the most urgent conditions in medicine, lead to hypovolemic shock and death, if not recognized in time. The aim: of this work is to point out patients with unusual clinical pictures and unexpected circumstances. With them, how not to be late with a timely diagnosis and decision on further treatment? Presentation of case 1 - female patient, aged 57, who was brought by SHMP to the Reception and Triage Clinic of the Emergency Center twice during the night: the first time due to alleged alcoholism and impaired state of consciousness, after which she was referred to the VMA, and the second time she was returned from the aforementioned institution suspected aortic dissection, when, after regaining consciousness, she complained of chest pain. After a CT aortography and a confirmed dissection of the ascending aorta, she underwent urgent surgery. The slow postoperative period with complications ended with a positive outcome, she was discharged from the hospital after 15 days. Presentation of case 2 - patient, 35 years old, who comes to the Emergency Center with severe pain in the epigastrium, which started 1 hour ago. After a suspicious ultrasound finding, elevated D-dimer and pain resistant to analgesia, a good decision was made to perform CT aortography, which indicates thrombosis of the superior mesenteric artery. He was operated on urgently, then re-operated on, and was observed by the consilium all the time, but he died on the 15th day of hospitalization. Conclusion: Unusual presentations of thoracoabdominal pain should be kept in mind, due to timely diagnosis and treatment