EKG Interpretation: Dr. Schuerch’s EKG from the CCU

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  • sannman

    NSR @ 65. R axis deviation, R bundle branch block, peaked T waves throughout (I, II, aVL, V3-V6). Give the hyperK cocktail, just throw that kitchen sink at him: calcium, D50, insulin, kayexelate.

    Another thought. It almost looks like there are buried P waves in the QRS complexes, maybe even in the T waves, if you follow lead II strip. Though this is probably just be the QRS splitting due to RBBB.

    • alvarezzy

      another reason to give calcium (loss of p waves and qrs widening)… one of tesfa’s petpeeve’s with chiefs… giving calcium on hyperK patients with just hyperacute t waves.

  • mmegue01

    I think this looks like Hypothermia as well. I suspect those are osborn waves in most of the leads and the conduction delays are consistent with hypothermia. I would have expected a touch more bradycardia. It is curious that this would be a case in the CCU at this time of year, however…so a little curious what the clinical situation surround this patient is.

  • mmegue01

    Considering the dude’s clinical history, I’d be very worried about Hyperkalemia due to obstructive etiology. So I would hit him with the hyperK cocktail and hope that after giving Calcium his QRS complexes would tighten up.

  • alvarezzy

    not sure if that’s osborn waves or just from the RBBB. agree with hyperK cocktail, but probably not do kayex given recent literature, but if renal really wants it, would not fight them for it. would be cautious in giving it to someone with bowel gastropathies though.

    have been using lasix more lately but especially in this “young” man, would place a foley first, as perhaps the reason why he’s in acute renal failure is 2/2 urinary obstruction, which lead to the hyperK. make sure pt is peeing and would follow the urine output.

    when giving calcium, we’re talking about LOTS of calcium and not just one amp of calcium gluconate. make sure IV is good and if I have an 18 or 16 gauge, will give calcium chloride. would connect the patient to the ekg machine, and watch that qrs narrow. don’t forget the bicarb/insulin IV (not subq)/d50/continuous albuterol. check glucose and if low, give 2 amps of d50.

    recently had a guy in the complete HB, HR in the 30s with long pauses 2/2 hyperK 9.3, and took 3 calcium chloride to finally see p waves and for beats to be regular. he was on spironolactone and lasix, and was only taking the former.

    i’d call renal just in case medical management is not enough.


    what’s the real answer???

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