The setting:
Busy Saturday morning shift. Lots on the go as usual…
You sit for a moment to catch up on your notes and review patient results…
A nurse hands you this ECG to sign-off saying, “this lady is generally unwell and has been drowsy & vomiting for 3 days. She doesn’t look well but doesn’t speak any English”…..
What’s your interpretation ?
There will be a 4-5 hour wait for her to be seen…
Where do we go from here ?? What do you do next ??
…. the conclusion can be found here –> generally unwell (part 2) …
Interesting.
So first thing that jumps out at me is those T waves they are peaky. friend used to call them “teepees”
3 days of Vomiting + those changes = Electrolytes up the river. ?hyperK
Had you managed to eyeball her at all at this stage. Also, dont ever sit down if you want peace in ED. I find you get harrased less if you lean and write. =)
Lessee… QT looks longline PR looks long, peaked Ts, widening QRS, axis is WAY off (I’ve never seen every precordial lead ‘about’ isoelectric). Freaky ECG! HyperK at top of the list (but why? Tox, renal, meds). Need labs (lytes, renal, CBCD, liver, tox, venous gas…). Don’t think Calcium would hurt (famous last words), salbutamol, little bit of NS… Monitor…. Wait with bated breath…
1st degree AV bock with QRS widening, hyper acute T waves and extreme Rightward axis deviation. Consider Renal failure as precipitating cause of suspected hyperK+. Rx IV Ca+, Sodium Bicarbonate, neb Salbutamol if K+ >5.5mmol
Sorry for the slow reply team !!
– Part 2 says, you were all spot on (!!!)
– Agreed with your comments and trekked to her bedside to get an urgent K+ off….
the results can be found in the sequel !
Thanks for contributing.
CP.