What is the rhythm?

A patient was found down approximately 30 minutes after taking methamphetamine.  Bystander CPR.  Medics found patient in PEA arrest.  He was resuscitated into a perfusing rhythm.  He went in and out of arrest until arrival at the ED.  Here is the only prehospital 12-lead:Sinus tachycardia, somewhat wide QRS, IschemiaHere is the first ED ECG:What is the rhythm here?This ECG is pathognomonic of hyperkalemia, with wide QRS, very SHARPLY peaked T-waves, flat ST segments, RBBB pattern and large R-wave in aVR.  What does that say about the rhythm?  It is regular.  It is supraventricular.  It is not tachycardic.  Is this an accelerated Junctional rhythm?  Junctional rhythm is possible, but most likely is" Sinoventricular rhythm ".  Sinoventricular rhythm is a supraventricular rhythm that is initiated by the sinus node but does not manifest with P-waves because the hyperkalemia completely flattens the P-wave.The K returned at 7.8 mEq/L.Core temp was 40 degrees C.  The remaineder of the case was complicated and the patient ultimately died.See here another case of sinoventricular rhythm:And more cases discussing Sinoventricular Rhythm:https://hqmeded-ecg.blogspot.com/search/label/Sinoventricular%20RhythmKen Grauer(below) has a different opinion; I ' m not sure I agree but it ' s good to have multiple viewpoints!===================================MY Comment, by KEN GRAUER, MD (4/30/2024):=====...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs