tag:blogger.com,1999:blog-549949223388475481.post8369974068651241090..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Massive Transfusion for Motorcycle Collision with Hemorrhage, Troponin Elevated.Unknownnoreply@blogger.comBlogger2125tag:blogger.com,1999:blog-549949223388475481.post-36697786457991435932020-07-05T14:09:09.553-05:002020-07-05T14:09:09.553-05:00THANKS so much Anderson for your comment! I fully ...THANKS so much Anderson for your comment! I fully acknowledge that I do not know for certain that in ECG #1 there is a sinoventricular rhythm with additional QRS widening due to hyperkalemia. This is just my hypothesis. But I think it important to be aware of the concept of “sinoventricular rhythm” when there is hyperkalemia, as I suspected from other findings in ECG #1 that there transiently was. Your question is an excellent one — and it will NOT always be possible from a single tracing to distinguish with certainty between AIVR vs a hyperkalemic sinoventricular rhythm. This is my “Pearl #4” — in which I emphasize that sometimes it will only be with serial tracings and careful observation (with close correlation of serum electrolyte levels AT THE TIME each serial tracing is done) — that you’ll see the gradual evolution of P wave and QRS findings that will tell you if my hypothesis was correct. As a final point — I’d add that typically with AIVR — QRS morphology will NOT be as typical as it is here for RBBB (See what I wrote above under “Regarding QRS Widening in ECG #1”). De novo, muito obrigado pelo suo comentário (Again — Thanks a lot for your comment! — :)ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-65713754685611722652020-07-05T13:09:38.474-05:002020-07-05T13:09:38.474-05:00Excellent case and great explanation!I have mistak...Excellent case and great explanation!I have mistaked the rhythm ECG #1 as AIVR, because there are not P waves, QRS is wide and HR is 120 bpm. But this just demostrated that as per DR Smith statemented in this blog "Hyperkalemia is called the "syphilis of ECG findings" because it comes in so many forms". I'd like to know: How can i differentiate between AIVR and hyperkalemic sino-ventricular rhythm?<br />Anderson Santos from Brazil. Thanks a lot my teachers!O Poder da Eletrocardiografiahttps://www.blogger.com/profile/11143192155299060176noreply@blogger.com