ECG:

This is a 12 lead ECG with normal caliberation at 10mm/mV and 25mm/s

1.Rhythm: look between R-R if same distance then rhythm is regular(sinus
rhythm)
2. Rate :
Regular rhythm: 300/ no. of large boxes between two QRS complex
Irregular rhythm : count the no. of beats
for 6 sec. multiply by 10
3. Axis: normal QRS axis is -30 to +110
see QRS complex in lead 1 and aVF
4. See individual wave:
Assess P wave { <2.5 small square in duration and amplitude}
QRS complex normal duration: 0.04 to 0.11 sec
T wave
5. Calculate intervals
normal PR interval 0.12- 0.20 sec
normal QT interval 0.35-0.45 sec
6. Assess for hypertrophy
• RVH – tall R in V1 with R>S
Deep S wave in v4, v5 and v6 and assoc. right axis deviation
• LVH – S wave length in v1 + R wave length in v5 or v6 > 35mm
7. Look for ST segment abnormalities.

At last comment on ECG findings

Probably the ECG will be of…………
Normal ECG:
Anterior wall MI : ST Elevation in v2, v3, v4 and reciprocal changes (ST depression
in lead III)
Inferior wall MI : ST Elevation in lead II, III and aVF and reciprocal changes (ST depression in
aVR , aVL, and V2)
Atrial Flutter: atrial rate>300bpm, absent p wave and saw toothed appearance.
Atrial Fibrillation: atrial rate approx. 400-600bpm and ventricular rate approx.
150bpm, irregularly irregular RR interval or rhythm , no visible p waves.
Bradycardia: heart rate < 60bpm
Hyperkalaemia: tall peaked T waves >5mm in the limb leads and >10mm in
chest leads
WPW syndrome: delta waves(slurring slow rise of initial portion of QRS complex) in
all leads.(pre excitation due to atrioventricular bypass tract aka bundle of Kent.)
Torsades de pointes: polymorphic ventricular tachycardia characterized by a
gradual change in the amplitude and twisting of QRS complexes around the isoelectric line.
 Normal Xray:
This a digital Xray PA view/AP view
with Well exposed inspiratory film
With normal rotation and angulation
showing breast shadows ,supraclavicular
areas axillae and bony structures such as
Shoulder girdle, clavicle, no. of ribs,
sternum ,no. of vertebral bodies with
Spine.
Trachea is central
Right /Left hemiDiaphragm is dome
shaped
Cardiophrenic angle and costophrenic
angle is clear/ blunted
Lung field are clear/ consolidated
Cardiac border and shadow
This xray probably suggest:
Pleural effusion:
PTB
Emphysema
Pneumothorax
Pneumonia
Drugs:
1. Inj. Hydrocortisone 13. Inj. Ceftriaxone
2. Inj. Sodium bicarbonate 14. Snake venom antiserum
3. Inj. Tramadol 15. inj. Levetriacetam
4. Inj. Calcium gluconate 16. Inj. Iron sucrose
5. Inj. Neostigmine 17. Inj. Streptokinase
6. Inj. Diazepam 18. Inj. Atropine sulphate
7. Inj. Amiodarone 19. inj. Ondansetron
8. Inj. adenosine 20. inj. Noradrenaline
9. Inj. Aminophylline 21. inj. Adrenaline
10. Inj. Phenytoin 22. inj. Enoxaparin
11. Inj. Pantoprazole 23. inj. Paracetamol
12. Inj. Amikacin 24. inj. methylprednisolone
25. inj. Regular insulin
26. Tab. furosemide
27. Tab. Metformin 500mg
28. Tab. Glimepride 2mg
29. Tab. Metoprolol 50mg
30. Tab. Alprazolam 0.25mg
31. Tab. Amlodipine 5mg
32. Tab. Telmisartan 40mg
33. Tab. isosorbide dinitrate 5mg
34. Tab. Aspirin 75mg
35. Tab. Clopidogrel 75mg
36. Tab. Atorvastatin 40mg
37. Tab. Diltiazem
38. Inj. Piperacillin tazobactum
39. Inj. Vancomycin
40. Inj. Tranexamic acid
41. Inj. Magnesium sulphate
42. Inj. Artesunate
ORS Powder
Normal saline
Ringer lactate
DNS
Instrument:
1. Foley’s 10. Laryngoscope
11. Syringe
2. Ryle’s 12. Tunning fork
3. Suction catheter 13. Knee hammer
4. Urine bag 14. Triway
5. Infusion set 15. Insulin syringe
6. Blood transfusion set 16. Laryngeal mask airway
17. Stethoscope
7. Volume drip set
18. Quincke’s needle
8. Endotracheal tube 19.Cannula (green, pink, blue)
9. Ambu bag and mask