EKG of the Week 2018 5-27

This EKG comes courtesy of Dr. Litvak and Dr. Calabro.

A 59 y/o male with no significant past medical history presented to the ED complaining of weakness and shortness of breath. He had been fatigued for several weeks. He presents drowsy.

V/S: Pulse 120, Respirations 28, BP 180/90.

His EKG is below.

2018 5-27.jpg
  1. What does the EKG demonstrate?
  2. How would you manage this patient?

 

ANSWER:

The EKG shows a wide QRS complex with an irregular rhythm.

This EKG is concerning for hyperkalemia. This patient’s Potassium was 9.9. He was treated with calcium, insulin, glucose, albuterol, bicarb and emergent dialysis.

 

Hyperkalemia causes a series of changes to the EKG. An early sign is peaked T waves. This is followed by flattening of P waves, widening of the QRS complex and ultimately a sine wave. Whenever you see a wide QRS complex with a bizarre rhythm or what looks like “slow V-tach”, think about hyperkalemia.

This patient was given calcium. The repeat EKG below shows some improvement in the rhythm but the QRS remained wide.

2018 5-27b.jpg

The patient was found to have AKI with BUN 225 and Cr 25. Blood gas showed pH 6.95, pCO2 16, HCO3 4. A foley was placed and the patient was anuric.

The patient was sent for emergent dialysis. After dialysis the EKG (below) shows a normal sinus rhythm with a narrow QRS complex.

2018 5-27c.jpg