Thursday, August 7, 2014

A Very Wide Complex

What do you think of this ECG from a critically ill patient?
See Below

I can only give minimal information in order to protect identity: this patient had such severe rhabdomyolysis (CK nearly 100,000) that continuous renal replacement therapy (i.e., continuous dialysis), in addition to Calcium and shifting therapy, could not lower his K enough to prevent cardiac arrest (other futility complicated this picture) .  This was severe hyperkalemia.  There are no P-waves. The QRS is bizarrely wide.  In places, it looks nearly like a sine wave.  The last K was drawn 20 minutes before the ECG, and was 7.9 mEq/L.


  1. Nice case , do you have any info how much Calcium was given , did he survive ?

    1. I believe 6 g of Ca gluconate. He did not survive, but for other reasons.

  2. Sine wave plus Brady cardia is alsoevident.

  3. When the QRS starts to splay and the p-waves go away, think hyper-K


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