How will you save this critically ill patient? A fundamental and lifesaving ECG interpretation that everyone must recognize instantly.

Written by Pendell MeyersA woman in her 30s called EMS for acute symptoms including near-syncope, nausea, diaphoresis, and abdominal pain. EMS arrived and found her to appear altered, critically ill, and hypotensive. An ECG was performed:What do you think?Extremely wide complex monomorphic rhythm just over 100 bpm. The QRS is so wide andsinusoidal that the only real possibilities left are hyperkalemia or Na channel blockade. Hyperkalemia is by far more common.Indeed, further history revealed two missed dialysis sessions. And of course on exam she has a dialysis fistula.EMS reportedly gave 4 grams of calcium (unknown whether CaCl or gluconate) and 50 mEq of sodium bicarbonate. There was concern that the rhythm might represent ventricular tachycardia, so lidocaine was given and one attempt at cardioversion was performed. It is unclear what changes happened to the rhythm based on the EMS interventions, but the patient arrived to the ED remaining critically ill and with a very wide complex reported (no ECGs from ED available sadly).Hyperkalemia was diagnosed and more treatment was given including more calcium, bicarb, insulin/dextrose, and albuterol.The potassium level returned at 9.7 mEq/L.Emergent dialysis was prioritized after stabilization. She did well and stabilized after dialysis. Here is her ECG the next day with normal potassium level:She did well.See our other countless hyperkalemia cases below:General hyperkalemia cases:A 50s year old man with lightheade...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs