Monday, November 3, 2014

EKG Challenge #3 - A Case of the Dizzies

You are working on a busy night in TCC when an elderly lady is brought in by EMS with a complaint of dizziness. The paramedic looks a bit more stressed than you expect for the average old lady with a case of the dizzies and rightly so. As he reports her vital signs, you are shocked to hear that her HR has been steadily below 30 with a systolic blood pressure in the 80s and you’re even more shocked to hear that she’s awake! She reports feeling generally weak and thinks she has the “stomach flu”.  As the nurses get down to business placing the patient on the monitor and obtaining IV access, the tech hands you this EKG.

Interpret the EKGWhat is your differential?  What would you do next?
See the case conclusion HERE


  1. Place pacer pads. Check potassium, possibly very low. Check Magnesium. Check Calcium. Check temperature. I can't tell if there's clearly a P wave preceding every QRS or not. There's a regular R-R interval, but it's either a junctional rhythm or very small P waves on this EKG.

  2. I agree with Drew’s workup- Check electrolytes, temperature. I would also want the patient’s med list looking for CCB or beta blockers. I agree there are not clearly P waves before every QRS. The T waves look large/peaked in comparison to the QRS complex, making me think more hyperkalemia. There is no U wave that would be expected with hypokalemia. I would place pacer pads and have atropine bedside.

    1. I was thinking of a more evolved hypokalemia, where T waves are almost absent and all you see are large U waves, since it looks like a T wave and U wave in precordial leads. These post-QRS waves didn't seem pointy enough for peaked T waves. Also, I would be doing a more grand workup than just the things I mentioned above: troponins, thyroid studies (eval for myxedema coma, though this is usually with inverted T waves), infection/sepsis. Always gotta check meds in old folks.