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 0.16â
Eighth & ninth strips:
Progressive sinus bradycardia 32 - 30/min. Left atrial abnormality. Progressive first degree AV block, PR interval 0.24 - 0.34â. 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 Ådema, shortly before a Code 5 (Code Blue). What sign of impending arrest (asystole followed) is present on the strips below?
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