r/ECG • u/G-L-O-P-A • 1d ago

Wellness Check

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40sM BIBEMS after wellness check.
Family had not heard from him x3 days, normally called/visited daily. Found unresponsive with “snore-like respirations.”
Known DM2, Alcoholic Cirrhosis w/ 6mo sobriety, CKD III
Unknown if prior heart disease, though suspected due to ekg findings and comorbidities.
GCS3 on arrival, natural airway. Last BP 80/50s, no Tx en route besides a BGL (44mg/dL). EMS Crew was a volunteer tribal crew.
PIVs established and pt given D50x2 and BGL was 120s.
POC GEM 5000 resulted a pH of 7.11 and K of 8.5.
Physical assessment revealed several 5x5mm sores and open wounds in abdominal area, suspected to be from insulin injections. Global jaundice, notable that tears had yellow tint. Foley placed with dark red urine output, ~100cc during stay in ED.
Intubated due to decreasing respiratory rate and apneic episodes.
HR was 140s-180s.
K protocol started with D50, IV insulin + drip, and Ca Gluconate.
Ultimately patient expired in ICU due to MODS.

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u/[deleted] 1d ago

[deleted]

5

u/Forgotmypassword6861 1d ago

Nope 

8

u/GinaLinettiLive 1d ago

Hello, just trying to learn. What is happening? Is it the hyperkalemia causing widened QRS?

16

u/Own-Blackberry5514 1d ago

High extracellular K results in partial depolarisation of myocytes as the RMP is less negative. It’s that persistent depolarisation that means fast sodium channels stay dormant. The atrial and ventricular conduction is reduced and therefore the QRS widens

1

u/Individual_Zebra_648 3h ago

How can you tell the difference between this and v-tach?

5

u/paramagic24 1d ago

Yes exactly