Agonal Hyperkalæmia

Report:

Top two strips:

Atrial fibrillation with rapid response.Ventricular tachycardia, non-sustained

Third strip:

Ventricular tachycardia 146/min ?retrograde conduction

Fourth strip:

Sinus tachycardia 130/min

Fifth strip:

Sinus bradycardia 40/min. Peaked T waves

Sixth strip:

Sinus bradycardia 39/min. Left atrial abnormality. VEB with retrograde conduction. Peaked T waves

Seventh strip (top, second panel):

Sinus bradycardia 43/min ?junctional rhythm. Peaked T waves. Intraventricular conduction delay, QRS 0.16”

Eighth & ninth strips:

Progressive sinus bradycardia 32 - 30/min. Left atrial abnormality. Progressive first degree AV block, PR interval 0.24 - 0.34”. IVCD, VEBs

Tenth strip:

Broad-complex rhythm 40-55/min. QRS/T merged together

Bottom two strips:

Multiform ventricular tachycardia. Slow ventricular fibrillation

Comment:

The agonal progression is typical of hyperkalæmia. It is usually impossible to separate it from the effects of acidosis and hypoxæmia also present.

242. 80 year old woman with acidosis, hyperglycæmia and pulmonary œdema, shortly before a Code 5 (Code Blue). What sign of impending arrest (asystole followed) is present on the strips below?

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