68 y.o. male w/ weakness: conclusion – “Treat the monitor.”
But perhaps not the computer…
Recap of the case:
A patient with CHF, COPD, and diabetes called after falling, apparently due to weakness. Their ECG was recorded by the paramedic:
Interpretation:
The underlying rhythm is unclear, due to artifact, but there are very wide QRS complexes. The computer measures the QRS as 158 ms, which is clearly wrong. A conservative measurement in V1-V3 suggests a width of at least 200 ms.
Such a wide QRS would be unusual for a bundle-branch block, as Dr Stephen Smith has pointed out. Of course, this could be a ventricular rhythm, but the classic sine-wave pattern (best seen in V1, and V5, V6) instead suggests severe hyperkalemia.
On the other hand, there is no bradycardia, there are no “tented” T-waves, and the absence of atrial activity is likely just due to pre-existing atrial fibrillation. But the wide QRS and characteristic QRST morphology overwhelmingly points to hyperkalemia.
Other examples of ECGs of severe hyperkalemia show much the same pattern:
Dr Smith’s ECG Blog: “This is a quiz. The ECG is pathognomonic.“
Life In the Fast Lane
Dr Smith’s ECG Blog: End-stage Hyper-K
Clinical course
The paramedic proceeded to a PCI center that was also “right around the corner,” so she fortunately did not have to make that decision! But she decided against requesting a prehospital activation of the cath lab, despite the computerized interpretation, feeling that hyperkalemia was far more likely. In the ED they r...
Source: EMS 12-Lead - Category: Cardiology Authors: Brooks Walsh MD Tags: Uncategorized Source Type: research
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