“Steve, what do you think of this ECG in this Cardiac Arrest Patient?”

I was shown this ECG.  The resident asked: “Steve, what do you think of this ECG in this Cardiac Arrest Patient?”

What do you think?

Here is more history:

An elderly woman with h/o CAD and CABG presented after out of hospital cardiac arrest with subsequent resuscitation and return of spontaneous circulation.  It was an unwitnessed arrest and down time was unknown.  The initial prehospital rhythm was asystole.

Here is the initial ED ECG:

Rhythm is regular, but no definite P-waves are visible.
There is a Brugada-like morphology in V1.
There is profound ST elevation in lead III and aVF, with ST depression in aVL
There is profound ST depression in V2.
What else?

Here was my response:

“What was the potassium?”

Answer: 7.6 mEq/L

The QRS is very wide.

Case continued:

The physicians thought this was STEMI and activated the cath lab.

Cardiology opined that this was a metabolic ECG.

Later, the K returned and they treated the hyperkalemia aggressively.

There was a complex resuscitation which included, among other medications, administration of calcium and insuline.

1 hour later, this ECG was recorded:


See these other hyperK cases also:

Case 1.  A Tragic Case

This patient presented with weakness.

45 minutes later:

Case 3 
PseudoSTEMI due to Hyperkalemia

Case 4

PseudoSTEMI due to hyperkalemia

Also, see this collaborative post on critical hyperkalemia written by Pendell Meyers with edits by Steve Smith and Scott Weingart:

EMCrit – Critical Hyperkalemia by Pendell Meyers

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