RESUMO
Compensatory tachycardia, an increased heart rate responding to stressors, requires careful consideration in treatment. This case report outlines a scenario where emergency medical services (EMS) misinterpreted a patient's electrocardiogram (EKG) as paroxysmal supraventricular tachycardia (PSVT) and administered adenosine, resulting in sudden cardiac arrest. Despite the rarity of deaths post-adenosine, this case highlights the potential risks of its use in inappropriate clinical scenarios. The patient, later diagnosed with a pulmonary embolism, had a compensatory heart rate that was disrupted after adenosine administration. While adenosine remains a safe and effective treatment for PSVT, this case report serves as a warning to EMS systems about the risks associated with its increased misuse, especially given the trends of prehospital EKG misinterpretation.
RESUMO
OBJECTIVE: Mediastinal masses are commonly encountered by the thoracic surgeon. Few studies have reported on the frequency and characteristics of symptoms at presentation. The primary objective of this study is to determine how often patients present with symptoms from a mediastinal mass. The secondary objective is to determine if the presence of symptoms has an effect on outcomes after surgery. METHODS: A retrospective review of an institutional database was performed. All patients who underwent surgical resection of a mediastinal mass from 2013 to 2019 were included in the analysis. Medical records were reviewed for the presence or absence of symptoms preoperatively, and these cohorts were compared. Multivariable analysis was performed, adjusting for clinical variables to assess for differences between these cohorts. RESULTS: 70 patients underwent surgery for a mediastinal mass. The average age was 49.2 years, and 46 patients (65.7%) presented with symptoms. There were no significant differences in demographics between the symptomatic and asymptomatic groups. The most common symptom was dyspnea in 18 patients (22%), followed by chest pain (15 patients, 19%) and dysphagia (8 patients, 10%). When comparing symptomatic and asymptomatic patients, symptomatic patients had a larger tumor size (5.8 cm vs 3.8 cm, P = .04) and a longer length of stay (2.0 days vs 1.2 days, P = .02). CONCLUSIONS: The majority of patients with mediastinal masses present with symptoms, with the most common symptom being dyspnea. Symptomatic patients are more likely to have a larger tumor and tend to have a longer length of hospital stay postoperatively compared to asymptomatic patients.