ECG Elecerolyte Abnormalities

4

46Young

Level 25 EMS Wizard
Messages
3,063
Reaction score
90
Points
48
Does anyone know of a site that lists all common electrolyte abnormalities and their resultant pregressive ECG changes? My intent is to have a page(or several) for a quick reference. Thanks in advance.
 
The most important one to know (by far) is hyperkalemia.

The progression is from peaked T waves to a flattening of the P wave, widening of the QRS complex, and a merging together of the S wave and T wave (so-called sine wave ECG).

The history is usually significant for renal disease and the classic presentation is a missed dialysis appointment.

The sine wave ECG is sometimes referred to as "slow VT" since P waves are often absent by that time but the rate is < 100.

Anytime you have a QRS complex that approaches 200 ms you should be very suspicious of hyperkalemia.

Type 'hyperkalemia ecg' into the image search engine at Google to see some examples.

Tom
 
Thanks both for the reference materials. Would there be a chart available that gives examples of typical ECG changes for each category? It would be helpful to have a handy reference chart while in the field.
 
46,
Let me know how to e-mail you a flash chart. You'll love it.
 
TomB said:
The most important one to know (by far) is hyperkalemia.

The progression is from peaked T waves to a flattening of the P wave, widening of the QRS complex, and a merging together of the S wave and T wave (so-called sine wave ECG).

The history is usually significant for renal disease and the classic presentation is a missed dialysis appointment.

The sine wave ECG is sometimes referred to as "slow VT" since P waves are often absent by that time but the rate is < 100.

Anytime you have a QRS complex that approaches 200 ms you should be very suspicious of hyperkalemia.

Type 'hyperkalemia ecg' into the image search engine at Google to see some examples.

Tom
Click to expand...


Why is hyperkalemia important to detect in the prehospital environment? Are there any drugs typically carried on an ambulance that should be used with caution in the hyperkalemic patient?
 
It's important because it can kill your patient quickly and they are very difficult to resuscitate once they arrest. If you can recognize life threatening hyperkalemia and give the patient calcium gluconate/calcium chloride, sodium bicarb, and nebulized albuterol, you can save the patient's life.

Even if you pick up on it and report it to the hospital so it can be treated immediately, it can have a positive impact on patient care. Unfortunatley, life threatening hyperkalemia usually goes unrecognized in the prehospital setting. It's often mistaken for a ventricular rhythm.

I've seen instances of attempted TCP with hyperkalemia, but never with capture (of course I could say that with almost every TCP case I've ever reviewed, whether they were hyperkalemic or not).

Tom
 
I've seen instances of attempted TCP with hyperkalemia, but never with capture (of course I could say that with almost every TCP case I've ever reviewed, whether they were hyperkalemic or not).
Click to expand...

Funny you should mention that, we had a hyperkalemic pt the other day. The pt was alternating between a widecomplex brad and asystole. TCP captured @ 60BPM, and 89 milliamps. It worked quite well till we arrived @ the hospital and the pt was given the bicarb, ventolin, calcium chloride combo, within 10 min he was mentating normally and in normal sinus @ 70 BPM.
 
Hellsbells said:
Funny you should mention that, we had a hyperkalemic pt the other day. The pt was alternating between a widecomplex brad and asystole. TCP captured @ 60BPM, and 89 milliamps. It worked quite well till we arrived @ the hospital and the pt was given the bicarb, ventolin, calcium chloride combo, within 10 min he was mentating normally and in normal sinus @ 70 BPM.
Click to expand...

Any chance you could scan the ECGs and email them to me or post them here?

Tom
 
You must log in or register to reply here.
Back
Top