A 20-something with DKA and a regular wide complex tachycardia

Medics were called to see a 20-something type 1 diabetic with h/o DKA who had altered mental status.He was found to have " Kussmaul " respirations and respiratory distress.He was not in shock, his blood pressure was adequate, and pulses were strong.He was put on the cardiac monitor:Regular wide complex tachycardia.A 12-lead ECG was recorded:Regular Wide complex tachycardia at a rate of 200.What do you think?If you ' re the medic, what would you do?Whenever there is a wide complex, especially in a patient with DKA, one should think of hyperkalemia (sinus rhythm, often with " invisible P-waves " ).However, this rate is too fast for sinus tach and the morphology is not right for hyperkalemia. Still, calcium is harmless and it is harmless to give 3 grams of calcium gluconate.He arrived in the ED in the same condition. He was hemodynamically stable but with altered mental status and respiratory distress. Cardiac echo showed hyperdynamic performance.  Blood gas showed severe acidosis, with pH 7.00, pCO2 25 and HCO3 of 6.  K retured at 4.5 mEq/L.He was treated with calcium, bicarbonate, and magnesium. He was intubated.He had this ECG recorded:What do you think?What do you want to do?Suppose the patient did not have altered mental status from DKA and was not intubated?Analysis: VT vs. SVT with aberrancy vs. sinus tachycardia with hidden P-waves. (With a rate this fast, and no inkling of P-waves, sinus is very unlikely but if you were not sure, you c...
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