What do you think of this ECG from a critically ill patient?
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.
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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.
Nice case , do you have any info how much Calcium was given , did he survive ?
ReplyDeleteI believe 6 g of Ca gluconate. He did not survive, but for other reasons.
DeleteSine wave plus Brady cardia is alsoevident.
ReplyDeleteWhen the QRS starts to splay and the p-waves go away, think hyper-K
ReplyDelete