A Sweet Wide Complex Tachycardia

A 29-year-old man with history of type 1 diabetes mellitus presents with two weeks of feeling ill that became worse over the previous two days. This included a productive cough, subjective fevers, and frequent vomiting. He reports no headache, chest pain, or abdominal pain. He has had financial problems after losing his job about a month earlier, and is currently living in a local motel. His brother brought him to the emergency department for evaluation after finding him in bed confused, with vomit on the floor.   He appeared ill, and was oriented only to self. Vital signs were blood pressure 78/43 mm Hg, pulse 146 bpm, respiratory rate 26 bpm, temperature 37.2°C, and SpO2 96%. A fingerstick glucose measurement read “high.” Intravenous access was established, initial laboratory tests were sent, and fluid resuscitation was initiated with 2000 mL 0.9% saline. A 12-lead ECG was obtained. Figure 1. Presenting ECG.   Given his extreme glucose level, his physician suspected severe diabetic ketoacidosis. The inciting cause was unclear, but the differential included inadequate insulin therapy, ingestion of alcohol or another substance that may have been an intentional overdose, myocardial ischemia, or infection.   We should begin with three questions with every ECG. Is the rate fast, slow, or normal? Is the QRS complex narrow or wide? Is the rhythm regular or irregular? The rate on this ECG is about 170 bpm, so he clearly has a fast tachyarrhythmia. The QRS is diffi...
Source: Spontaneous Circulation - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs