Waldo

A middle aged guy presented with syncope in our middle acuity area the other night and one of my fellow residents recognized brugada on the EKG.

The pertinent findings are the RBBB with ST elevation in V1-V3. Type 1, like the one picture above, also has T wave inversions. These EKG findings make up Brugada pattern, and when associated with syncope or other clinical characters it becomes Brugada syndrome.

Could have saved this Waldo's life, but he signed out AMA (against medical advice). Brugada is a fairly newly recognized syndrome, and still isn't very well understood. If it is caught, cardiologists can fit you with an AICD and with excellent survival results. If not you are at great risk for deadly arrhythmias. Some sources state it is one of the most common causes of sudden cardiac death in patients with structurally normal hearts.

We now return to our regularly scheduled program...

Where's Waldo?

I was enjoying a 3am breakfast after my shift with a good friend the other night and he said something that really rang true for me.

Emergency medicine is "Where's Waldo?"

I don't know if he heard this wonderful analogy from someone else, but I will never forget it.

The gist of it is, the people in an emergency department at any given time are like all the people in a Where's Waldo? picture. The sick people are Waldo. Some of them are obvious, have concerning complaints or abnormal vital signs, and get found right away. Most of them though are lost in the sea of people. You might have a full emergency department, 30 people in the waiting room and 10 new charts in the rack but you need to find Waldo. He is out there, hiding, waiting to be discovered. It is our job to treat everyone with the respect and diligence they deserve but we need to do this quickly and efficiently. We need to find that Waldo.


I loved these books when I was growing up, and this further supports why I love my job.

If I find an interesting Waldo here and there, maybe I will share...