Volume 2 - Issue 9
Silvera Samson Raja,*, Aslesha Vijaay Shethb
aMRCEM Resident, Kauvery Hospital, Chennai, India
bEmergency Care Physician, Kauvery Hospital, Chennai, India
Slip or Block
An 89 years aged gentleman, with past history of hypertension and Coronary Artery Disease (CAD), presented to Emergency Department (ED) with an alleged history of accidental fall at a temple while climbing down the stairs. He sustained injury on the right hip and right hand. Patient could not bear body weight since the fall.
Initial examinations at ED
Local examination of right leg
Local examination of right hand
Complete RBBB is defined by a QRS that is 120 msec or more with rSR in lead V1 and qRS in lead V6. Incomplete RBBB shows the same QRS pattern, but its duration is between 110-120 msec.
Diagnosis: Trifasicular Block
What is trifasicular block?
As there is a risk of asystole and syncope in tri-fascicular block, the fall can be either accidental slip or because of impending heart block.
A 48 h Holter monitoring is recommended to investigate the exact reason of fall - whether arrhythmia related or not.