A 51 year old male is brought to ED by his family. He was difficult to arouse this morning. No further history is known.
- Describe and Interpret the ECG
- What would be your initial management for this patient?
Answer
Rate : 90 bpm
Rhythm : Regular, P waves not seen
Axis/Segments: Indeterminant
Intervals: Broad complex with fusion of QRS complex and T wave leading to Sine Wave type pattern
In this clinical context where little information is known about the patient, differential diagnosis for this ECG would be severe hyperkalaemia or sodium channel blocker OD – TCA’s being the most common.
This ECG represents a patient who is critically unwell and periarrest. Immediate management would include:
- Ca Gluconate/Chloride 10ml 10% iv, while awaiting potassium results – urgent VBG should be done
- Sodium Bicarbonate – 1mmol/kg boluses. This will help treat hyperkalaemia and a sodium channel blocker toxicity.
- Further address ABC’s as required – remember to resuscitate before intubate!
- Obtain further history to guide further management
References
Dr Smiths ECG blog: http://hqmeded-ecg.blogspot.com/2015/03/weakness-and-dyspnea-with-sine-wave-its.html
ECG of the Week Dr John Larkin 26th March 2012