I received a couple of interesting 12-lead ECGs from a semi-regular contributor who still wishes to remain anonymous (which is perfectly fine with me).
It was a transport from the emergency department to a tertiary care center for emergent dialysis.
Here are the 12-lead ECGs captured en route.
Potassium was 8.1.
Congratulations to this paramedic for using this transport as a learning opportunity!
Here are some ECGs from a recent case 76 year old female CC: Diminished LOC.
Potassium was 8.3.
Here are some ECGs from “Rhythm Challenge #2“.
I don’t remember the exact potassium level but it was above 8.0.
I don’t think we ever got a potassium level on this poor fellow but he died.
Life-threatening hyperkalemia is something you can expect to see in the course of your career and it’s treatable!
It’s one of the few conditions (like D50 for insulin shock) that we can treat with IV meds (calcium gluconate or calcium chloride) and have an immediate therapeutic effect.
Take a close look at these ECGs and learn what to look for.
- Undetermined rhythm (absent P-waves)
- Non-specific intraventricular conduction defect
- QRS duration > 180 ms
- So-called “sine wave” or “Z-fold” appearance (merging together of S-wave and T-wave)
Throw in a history of renal insufficiency or renal failure, a missed dialysis appointment, use of potassium sparing diuretics, potassium supplements, etc., and you should be able to clinch the diagnosis.