tag:blogger.com,1999:blog-549949223388475481.post7075266420292037140..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Weakness and Hypotension, with Bradycardia.Unknownnoreply@blogger.comBlogger13125tag:blogger.com,1999:blog-549949223388475481.post-27979310680198869542017-05-22T08:56:04.173-05:002017-05-22T08:56:04.173-05:001-2 minutes1-2 minutesSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-10014718933831506342017-05-22T08:55:22.219-05:002017-05-22T08:55:22.219-05:00Calcium is very safe, except in patients on Digoxi...Calcium is very safe, except in patients on Digoxin. I have given 15 g of Cagluconate before (5 g of CaCl). You can give more if the patient is in danger.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-33675572546415520652017-05-22T08:54:03.841-05:002017-05-22T08:54:03.841-05:00We gave 1 g at a time and assessed response. It i...We gave 1 g at a time and assessed response. It is safe.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-5664633222134487732017-05-21T02:32:23.863-05:002017-05-21T02:32:23.863-05:00How slow do you push the calcium chloride? 1-2 ml/...How slow do you push the calcium chloride? 1-2 ml/min or faster? Good case!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-25077061271643125132017-05-20T16:10:22.919-05:002017-05-20T16:10:22.919-05:00NICE case. I also contemplated concurrent hypocalc...NICE case. I also contemplated concurrent hypocalcemia (because of the relatively normal and long ST segment with modest T wave peaking) — but as per Dr. Smith ionized Ca++ only minimally low whereas K+ was greatly increased. Highly insightful case of marked hyper-K+ producing significant bradycardia, loss of P waves, but modestly altered T waves (with a wide not narrow base), and without QRS widening! Biggest CLUE in this case = the History ( = dialysis patient). Thanks for presenting!ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-18066696373024524602017-05-20T10:19:12.097-05:002017-05-20T10:19:12.097-05:00You gave what seems to me a large amount of CaCl2,...You gave what seems to me a large amount of CaCl2, 1 G X 3. You gave up until the rate improved? What would be your max dose of calcium? You give it slowly ( 5-10 minutes )?Dominic Larose MD CMFC(MU) FACEPhttps://www.blogger.com/profile/12841805037815499459noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-7532467365779066642017-05-20T10:01:32.267-05:002017-05-20T10:01:32.267-05:00Why 3 grams of CaCl2? Seems like a lot. What's...Why 3 grams of CaCl2? Seems like a lot. What's your approach on how much calcium to give a hyperkalemic patient? Thanks!Who is writing this?https://www.blogger.com/profile/04263291673560984779noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-34977795169180775552017-05-20T06:27:01.390-05:002017-05-20T06:27:01.390-05:00Dr. Smith,
As a field Medic, I certainly would hav...Dr. Smith,<br />As a field Medic, I certainly would have had hyperK in my differential knowing the patient was a dialysis patient. But the notion "Bradycardia is hyperK until proven otherwise" is new to me and certainly not known in Paramedicine. *Mind blown.Anonymoushttps://www.blogger.com/profile/02943516745956266186noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-26145422773132844302017-05-19T08:46:46.918-05:002017-05-19T08:46:46.918-05:00I thought it was hypocalcemia as wellI thought it was hypocalcemia as wellAnonymoushttps://www.blogger.com/profile/13289829982922184076noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-11079807147166255622017-05-19T07:09:21.510-05:002017-05-19T07:09:21.510-05:00Peter,
As far as I know, it attenuates all the eff...Peter,<br />As far as I know, it attenuates all the effects of hyperK. for certain, it narrows the QRS.<br />Atropine is a good idea.<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-58350137815800716072017-05-19T07:07:47.925-05:002017-05-19T07:07:47.925-05:00good observation, but in this case the ionized Ca ...good observation, but in this case the ionized Ca was 4.37 (only slightly low)Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-33622869987547699892017-05-19T06:04:43.793-05:002017-05-19T06:04:43.793-05:00Steve,
Several guidelines state that iv calcium in...Steve,<br />Several guidelines state that iv calcium in the setting of hyperK is to prevent Vfib. Would you say that it has a direct effect on hyperK-induced bradycardia? From my own (rather limited) experience they do respond with normalisation of the rate/rhythm. However my patients had also received atropin by the paramedics.<br />/PeterP Hammarlundhttps://www.blogger.com/profile/12795866723817205360noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-17913845212400777422017-05-19T01:40:33.607-05:002017-05-19T01:40:33.607-05:00Could the EKG be typical of hypocalcemia? Long ST...Could the EKG be typical of hypocalcemia? Long ST with normal T wave ?? Hypocalcaemia is common in patients with dialysis and in patients with hyperkalemia... Doinelhttps://www.blogger.com/profile/13529305662308020795noreply@blogger.com