A 60-something who has non-specific generalized malaise and is ill appearing.

An anonymous paramedic sent this.A 60-something with past history only of colon cancer called 911 for non-specific generalized malaise.The medics state that he was ill appearing.They recorded an ECG:What do you think?This is extremely wide, and even if it is VT, it is so wide that there must be hyperkalemia or a severe Na channel blocking overdose.  The patient was not on a sodium channel blocker.The paramedic knew instantly what it was (he credits his regular reading of this blog!)The patient was only a couple blocks from the hospital, so there was no time for treatment before arrival.K was 8.9 mEq/L.Etiology was a combination of NSAID and obstructive nephropathy, with a Cr> 20 (!).  Estimated GFR of 2.0.The potassium was brought down and the patient ultimately did well.
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs