Hyperkalemia
Results:
Baltimore City EMS ECGs: Pitfalls and Mimics (Part 2)
A 54-year-old man presents to the emergency department by EMS with acute shortness of breath. A prehospital ECG triggers a STEMI alert based on the computer interpretation. The tracing shows…
Baltimore City EMS ECGs: Pitfalls and Mimics (Part 1)
A 68-year-old man is brought to the emergency department by EMS with acute chest discomfort. The following prehospital ECG was obtained and shows concave ST elevation across multiple leads. The…
Hyperkalemia
Key Points: ECG as a Frontline Diagnostic Tool: Hyperkalemia often reveals itself on the ECG before lab confirmation. Early recognition of characteristic changes can be life-saving, especially in critically ill…
Hyperkalemia Emergencies
Key Points: Severe Hyperkalemia Mimics Several Life-Threatening Conditions: Severe hyperkalemia is one of the most dangerous ECG mimics in emergency medicine. It can resemble unstable bradyarrhythmias, VT, STEMI, and pacemaker…
STEMI vs Severe Hyperkalemia: DDx
Key Points: Severe hyperkalemia is a true ECG chameleon. It can produce ST elevation, wide QRS complexes, axis shifts, and conduction blocks that closely mimic STEMI or ventricular tachycardia. New…
The Post-Arrest Wide Complex Rhythm That Was Not VT
A 35-year-old woman arrives at the emergency department after a witnessed seizure and brief cardiac arrest with ROSC. Her arrival ECG shows a very wide complex rhythm that the machine…
The Post-Thanksgiving Rhythm You Cannot Miss
A 48-year-old woman presents two days after Thanksgiving with severe weakness, palpitations, and mild chest discomfort. Her ECG appears to show a very wide complex regular tachycardia at 119 bpm.
Ventricular Tachycardia (VT) Mimics
Key Points: Initial Assumption: Any wide (QRS >120 ms), regular tachycardia should be considered ventricular tachycardia (VT) until clearly proven otherwise. VT Characteristics: VT generally has a ventricular rate of…
AFib Overdiagnosis: Dangerous Pitfalls and Safer Reads
A patient presents to the emergency department with new-onset palpitations. He is hemodynamically stable but noted to have an irregular rhythm on arrival. The following ECG is obtained and automatically…
BRASH Syndrome
Key Points BRASH is a synergistic spiral: bradycardia, renal failure, therapeutic AV-nodal blockade, shock, and hyperkalemia. The signature clue is disproportionate brady-shock despite only modest potassium elevation. Do not be…
Regularly Irregular Rhythms: Sorting Mobitz from PACs and Other Causes
A 52-year-old woman presents to the emergency department with weakness. The following ECG is obtained:
Recent University of Maryland Medical Center Cases (Part V)
A 67-year-old man presents with profound generalized weakness and inability to move his extremities or get out of bed. He has a history of hypertension, chronic kidney disease, substance use…
Hyperkalemic Periodic Paralysis (Impressive Syndrome)
Key Points What It Is: A rare autosomal dominant sodium channelopathy that leads to episodic muscle weakness or paralysis in the setting of elevated serum potassium. Named after “Impressive,” the…
Unrecognized Killers in Emergency Electrocardiography
A 42-year-old man presents with fever, cough, shortness of breath, and vomiting. He appears toxic and dehydrated on arrival with suspected severe sepsis from multilobar pneumonia. He is later intubated…
2025 EMS Cases Part II
A 57-year-old man is being brought in by EMS for generalized weakness and vomiting. The following ECG is obtained and transmitted as a CODE STEMI alert:
A Decade of ECG Gems: Counting Down the Top 10 Cases
A 68-year-old man with PMHx of hypertension and tobacco use arrives at the emergency department with severe central chest pain and mild shortness of breath over the past 1-2 hours….
2024 UMMC Cases (Part II)
A 55-year-old woman arrives at the emergency department with shortness of breath and is noted to be tachypneic. The following ECG is obtained:
What’s Behind These Strange T Waves?
A 52-year-old woman presents to the emergency department with severe malaise and the following ECG is obtained:
Subtle ECG Changes and Diagnostic Challenges
A 70-year-old male presents to the emergency department with acute chest pain that sounds ischemic in nature. The following baseline ECG, arrival ECG, and repeat ECGs are obtained:
Interesting Cases from UMMC (2024 – Part I/III)
A 63-year-old man presents to the emergency department with acute chest pain and an episode of syncope. The following ECG is obtained, and the cath lab is activated for suspected…
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