Robbie

But honestly, when I see this, I think, okay, I can park the bus at Welland.

So when I see this, the patient's not going to be discharged.

And I think admitting the patient is key.

And the decision that's left for me in the ER is do I get a CTPE, yes or no?

And for me, the only thing that would stop me from getting a CTPE in this patient is if his troponin were disproportionately elevated, meaning that since his vital signs are not abnormal, if he has a PE, his troponin should be underwhelming.

But if his troponin is markedly high, I would be happy with the diagnosis of ACS and treat him as such.

So, Professor, I'm talking a lot, so maybe we can have a dialogue or whatnot, but I think I see this and I worry that an abrupt onset lightheadedness syndrome with this EKG change

really has, for me, PEACS in that order, with the troponin being a realistic tiebreaker between the two.

I'm also not, I've also been trained to think anytime that I think something potentially in the brain, and these changes not to overlook the possibility of cerebral T waves.

So I would want to do a really, really good neuro exam

Uh, and, uh, and review to see he's not on anticoagulant, which I don't think he has to make sure this is not the brain.

So that's my, that's my checklist.

Yeah, Prof. Rez, I think all that was in my mind was, as I said, exactly what I said to you, there's not enough blood getting to his brain.

Now, I don't do this in the ER because we move too quickly, but if I were to sit to that, it's not the only thing I know.

I also know that he abruptly stopped getting blood to his brain.

So if you ask yourself, like most people who have lightheadedness, what's the average story of lightheadedness?

We see this all the time, Prof Rez.

Hey doc, last three or four days, not feeling great, this, that.

And then you either get a story of diarrhea, diuretics, or you see that pesky Entrestor or ACE inhibitor and you're like, oh, okay, no problem.

So he's not that.