|
|
Post by pbruss on Sept 14, 2014 4:01:58 GMT -5
73 yo femal. ESRD on dialysis, does not make urine. comes in to ER fealing diffuly weak and run down for the past week. she is very reliable and has not missed any dialysis for months. denies any other symptoms, gradual onset, contunious since it began and slowly getting worse. her vilats and exam are all normal. attached is her EKG from this visit and her previous EKG. what is the next best step? A. bedside ISTAT with troponin B. chest x-ray C. bedise cardiac echo D. activat cath lab Attachments:
|
|
|
|
Post by Bjs04f on Sept 15, 2014 7:31:08 GMT -5
which is new ekg
|
|
|
|
Post by pbruss on Sept 15, 2014 8:22:59 GMT -5
The first one is the new EKG the second one is her previous
|
|
|
|
Post by Bjs04f on Sept 15, 2014 8:37:16 GMT -5
can I get a posterior EKG before deciding?
|
|
|
|
Post by kemple on Sept 15, 2014 21:13:30 GMT -5
can I choose E) K+ on IStat, longer PR, flattened P waves, slightly larger Ts. I don't see any severe ischemia there to warrant cath lab.
|
|
|
|
Post by pbruss on Sept 15, 2014 23:48:43 GMT -5
Kemple is right. I should have specified. bedside ISTAT with troponin is a bedside BMP with Trop. The trop was thorw in to make the decision harder - like on the boards. The EKG interp is spot on. It is very subtle but there are all the signs of hyperkalemia. her K was 7.5. attahced is the rythm strips for both EKGs to show the difference. I have never found a universal set definition of what a "peaked T wave" is. I use the following crieria: 1. Tall T waves are tall compared to the QRS. if the height of the T wave is aproching half the hight of the QRS then i get concerned. this patient is a good example. the T waves on her EKG in the ER were not very high but they were in compared to the amplitude of the QRS. 2. Peaked T waves are peaked if the are taller then they are wide. this lady also has an examle of that when you look at the strips side by sideAttachments:
|
|
