ECG Case 1

Question 1

HPC: Mr Grant is a 65 year old gentleman who presents to the ED feeling generally unwell. He reports several days of general malaise, nausea and poor appetite. He cannot remember all the medications that he takes, but informs you that last week he was started on a different medication for his heart but can’t remember what it is called. Today he feels generally unwell with weakness and can feel his heart skipping.

BG: significant for IHD, CHF, and CKD 4

O/E:-

Obs: RR 12, Sats 95% (OA), HR 100, BP 125/80, Temp 36.5

CVS: Warm and well perfused, CRT <2, HS I+II+O

Resp: Clear, no crackles

Answer 1

-

Question 2

This is his ECG. What are the main abnormalities seen?

Answer 2

1. Tall, tented T waves (V2 and V3)
2. absent P waves
3. widened QRS

Question 3

what is the likely dx?

Answer 3

severe hyperkalaemia

Question 4

how would you manage this pt?

Answer 4

• 10ml calcium gluconate 10% IV
• IV insulin and dextrose
• salbutamol nebulisers
• sodium bicarbonate

Question 5

What new medication was he likely to have been started on?

Answer 5

• ACEi/ARB
• aldosterone antagonist (spironolactone)
• beta blocker
• digoxin