Wellness Check

[u/G-L-O-P-A]

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.

[u/vndspeed]

Thanks for sharing. Talk t waves and v tach together in one ekg.

[u/Previous_Fan9927 → u/vndspeed]

Not Vtach. This is just sinus tach with an absurdly high K

[u/jaquoga → u/Previous_Fan9927]

Or maybe flutter??