FL_Medic Posted April 21, 2009 Posted April 21, 2009 (edited) I think this one may be a little easier. I have the story and a follow up on this one. Instructions for larger viewing from FireEMT: If you enlarge the image when you click on the part where it says to click to enlarge and it opens a new window click and hold the control key on your keyboard and then hit the + key. It will enlarge the image even larger as many times as your click it. If you do the same, but use the - key, it will make it smaller. This also works for normal web page viewing. It works in firefox, and internet explorer. Edited April 21, 2009 by FL_Medic
akroeze Posted April 21, 2009 Posted April 21, 2009 (edited) What is their potassium?? First thing that jumps out at me is those Ts in V leads Having said that, the elevation of the ST in V2-4 is there, and the printout isn't good enough to say if V5/6 also have it. Inverted Ts III and aVF Edited April 21, 2009 by akroeze
chbare Posted April 21, 2009 Posted April 21, 2009 Absolutely, look for history of renal failure, non-compliance, missed dialysis, and other causes of hyperkalemia. Take care, chbare.
fiznat Posted April 21, 2009 Posted April 21, 2009 I'm not completely sure (again), but I'll give it a shot. Looks like a sinus rhythm at 72 bpm. The complexes are narrow and the axis is in the normal range. The interesting part is obviously the precordial leads V1-V3. There are some FLBs ("funny lookin' beats haha) on the 2nd complexes which I guess we can call Q waves being that they are the first downward deflection after the p wave. Other than that I'm not sure what they are (possibly ectopy or some kind of fusion beat). The T waves are pretty peakey with some ST segment elevation as well. In my differential would be an impending MI (hyperacute T waves, ST changes) and hyper-K (peaked T, flatter P). The rest of the story and the patient's presentation should help differentiate between these two possibilities. Also of note is the r wave progression in the anterior leads, which point towards right ventricular hypertrophy. Is this patient a COPD'er?
akroeze Posted April 21, 2009 Posted April 21, 2009 Out of curiosity if we were to be highly suspicious that this was Hyper-K then with these ECG findings would you want to be treating it to bring it down? My understanding is as soon as you see any Hyper-K changes on the ECG it is already in the "dangerous" zone. Hyper-K is something I am still a bit cloudy on as far as the pre-hospital role in treatment of it.
scott33 Posted April 21, 2009 Posted April 21, 2009 Am I the only one seeing Osborn Waves here? What was his temp?
scubanurse Posted April 21, 2009 Posted April 21, 2009 Am I the only one seeing Osborn Waves here? What was his temp? Could you explain Osborn Waves? I get that it's hypothermia.. but what specifically do you look for on the EKG?
scott33 Posted April 21, 2009 Posted April 21, 2009 (edited) Also known as J-waves, they are the upward deflection between the QRS and the T-wave. Best seen in the V-leads here Edited April 21, 2009 by scott33
chbare Posted April 21, 2009 Posted April 21, 2009 Treating for hyperkalemia based solely on peaked T waves is not really indicated. Immediate pre-hospital treatment should be based on a high suspicion of having a condition causing severe hyperkalemia, hemodynamic compromise, and marked ECG changes such as wide QRS complex and presence of a sinusoidal rhythm. Unfortunately, you can also have a relatively normal ECG in the presence of severe hyperkalemia as well. Also remember life threatening cardiac complications can also occur with mild elevations in potassium. Also, medication effect and potassium imbalance can be quite problematic. Digoxin for example. In addition, I do not think we have ruled out other causes linked to what we see on this XII lead. Take care, chbare.
akroeze Posted April 21, 2009 Posted April 21, 2009 (edited) Treating for hyperkalemia based solely on peaked T waves is not really indicated. Immediate pre-hospital treatment should be based on a high suspicion of having a condition causing severe hyperkalemia, hemodynamic compromise, and marked ECG changes such as wide QRS complex and presence of a sinusoidal rhythm. Unfortunately, you can also have a relatively normal ECG in the presence of severe hyperkalemia as well. Also remember life threatening cardiac complications can also occur with mild elevations in potassium. Also, medication effect and potassium imbalance can be quite problematic. Digoxin for example. In addition, I do not think we have ruled out other causes linked to what we see on this XII lead. Take care, chbare. Just saying that IF this were someone who we think is HyperK such as ARF who missed their dialysis and we have this XII-lead would you start emergent Tx? Sorry if I'm being too simplistic here.... this is something that I really just want to have more of an understanding of. Edited April 21, 2009 by akroeze
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