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ECG library

Severe hyperkalemia: the widening QRS

advanced

Dialysis missed twice. Potassium 8.1. The QRS is stretching before your eyes.

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 T + wide QRS + vanishing P
  • Bradycardia
  • Sine-wave trajectory

Learning points

  • The ECG is the triage of hyperkalemia: width means calcium now, before the potassium result is even repeated.
  • The sequence is peaking, PR growth, P loss, QRS widening, sine wave, arrest, at any potassium slope.

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