From d/c home to admit to highest level of care possible...gotta love it!I diagnosed one a few months out of residency. 12-lead by EMS showed what looked like Brugada, but our EKG in the ER was normal. Had cardiology (you know who they are) come look at them, and they said he was fine and wanted to send him home. While they were down there talking to me, he went into VT for about 90 seconds. By the time we got the paddles on him, he was back in NSR. Repeat EKG showed Brugada. Cardiology ended up admitting him to the ICU. Go figure.
I had almost the exact same patient sometime in September, only one I've caught. No VT in the ED but had the heritage, family story, pattern, and ultimately inducible electrophysiology to confirm the Dx.I actually Dx'd one and it was textbook:
southeast asian male, young 20's, presented s/p syncope, two witnessed episodes of syncope in ED during which he went into brief episodes of v tach, family hx included father and brother who suddenly dies in their 30's for no apparent reason.
EKG displayed classic "saddleback" sign in V1-V3
I'm assuming you are joking, but would giving the patient an AED while they wait for their installment of an ICD be overkill?Not always. We usually just send a tech to "borrow" an AED from the mall, rig up some Zol pads, and send 'em out with the EP clinic number.
The same thing you'll do while waiting for implantation of the AICD... admit them. Syncope + Brugada would be a slam dunk for me. Still waiting to see it (and recognize it I should probably add).You have to order an AED in nearly all cities. So what are you going to do for the 2-3 days until it's delivered?