u/PaulaNancyMillstoneJ

38 yo M presented to ED yesterday with SOB. Only history is OSA on home CPAP and obesity type 3. Cx showed multifocal pneumonia and pt was positive for influenza A. Came to ICU for pressor support where we noted his QRS was wide despite no known cardiac hx. This is his EKG.

EDIT: Per NOC nurse, echo revealed EF 30-35% and high PAP. Intubated. Trops elevated, hemodynamics worsened, and subsequent ECG showed acute ischemia. Taken to cath lab and L heart cath found a 100% occlusion of the proximal LAD. Unable to stent, pt continued to deteriorate, now cannulated on ECMO.

70M admitted last night from OSH for a SAH. He was “Kentucky Healthy” with PMHx of DM2, HTN, & HLD - all managed well with medication. No cardiac history.

We received paperwork from the rural ER and this ECG was included. He presented with a severe HA and N/V, no cardiac symptoms noted in his paperwork. The ER physician had written “No STEMI, but consult cardiology” but I am really struggling to see why.

I can spot the limb lead reversal, but other than that it looks fairly unremarkable to me. What am I missing? Can anybody point out why the ER doc recommended a cards consult based on this?

First of all, thank you to everyone who responded and helped me out. A big part of my decision to call the city was hearing from other plumbers in my area, but then I posted here because I felt like such a jerk.

My husband scheduled this work, but the plumber working on our kitchen renovation told me a little bit about the company. It is the largest company in the area. They come up first on google because they pay for that, and they are pushy with customers to leave a 5-star review for a discount, which I already know because they had been incessantly asking for one. They therefore have over 5k 5-star reviews, despite us being in a moderately sized midwestern town. Their prices are a little predatory - for example, they sold my husband a "warranty" on their workmanship for the day of install which assured us they would do it correctly??? Also, he bought a membership, which gets us priority for future issues.

It turns out that not only did this company fail to pull a permit for the work, but the two guys that they originally sent out last week to replace the drain stack were just apprentices. These are the same two guys who came back the following day to diagnose the problem and failed to do so. We had to cut out the ceiling ourselves to find the open ended line. The apprentices are the ones who told us this would be a brand new project that we were on the hook for.

I sat on it over the weekend, did as much shop vac water remediation as I could and got a huge fan at home depot. I called the city on Monday and the company sent a journeyman plumber out to redo a bunch of the work, connect the drain, and vent the line. He admitted it was their mistake.

So the company was aware that I had called the city, and personally assured me that everything was fixed and buttoned up. The city came out today. They used caulk on the pipes that isn't right, so it was actively leaking while the city inspector was here. They also did not do the wet vent to code, as many of you pointed out. Pipe was 1.5" and it was 8 ft away from the toilet.

**TLDR: Had minor leak, apprentice plumbers replaced drain stack incorrectly and told us it was our fault. I called the city. They came and fixed it with caulk but the city showed up to a leaking pipe. Still no resolution. Pipe is leaking as I type this.**

Our subcontractor put screws into our 100 yr old oak floors to tile over them. He didn’t pre-drill pilot holes so a bunch of them split. Is this a big deal?

Click to see full text

ECG ordered by ICU team to check QTc. Pt is 56 yo male, hx cardiac arrest d/t hypoxia, currently intubated with ARDs. I initially called the physician to notify of TWI and my concern for ?Wellens in the setting of critical care. Pulmonary physician said it looked okay to him, did not think it needed to be read by a cardiologist. Was I way off base here?