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ECG library

Hyperkalemia

core

The 58-year-old from the lab module: weakness, potassium 7.1.

25 mm/s · 10 mm/mV · synthetic tracing
100%
IIIIIIaVRaVLaVFV1V2V3V4V5V6
II (rhythm)
Calipers:2000 ms50.0 small boxes30 bpm if R-RDrag the orange markers. One small box = 40 ms.

Key findings

  • Peaked tented T waves
  • Flattening P waves
  • Widening QRS
  • The end-stage is a sine wave

Learning points

  • The progression is ordered: peaked T, long PR, flat P, wide QRS, sine wave, arrest.
  • Any QRS widening in hyperkalemia is a calcium-now indication.
  • The ECG can be deceptively quiet; a critical potassium with any change is treated as an emergency.

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