Wednesday, June 9, 2010

Not Good

Challenge: Well...that's not good (yes, it's an EKG). Assuming it is not artifact, what's the differential diagnosis (H's and T's)? What is your next step in management?

Image shown under GNU Free Documentation License.

3 comments:

Mike said...

Hypovolemia, hypoglycemia, hypoxia, hydrogen ions (acidosis), hypothermia, hypo/hyperkalemia, trauma, tension pneumothorax, toxins, tamponade, thrombosis.

CPR w/ 1mg Epi IV/IO... Atropine 1mg if brady... and of course trying to correct the cause.

Anonymous said...

hyperkalemia

Craig Chen said...

yes! acls certified!
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Not Good

The EKG shows asystole. One simplified DDX involving the H's and T's suggests: hypovolemia, hypoxia, hydrogen ion (acidosis), hypo or hyperkalemia, hypoglycemia, hypothermia, toxins, tamponade, tension pneumothorax, thrombosis (PE or MI), trauma. Current ACLS guidelines suggest immediate CPR and epinephrine 1mg IV/IO repeat q3-5min; the first or second dose of epinephrine can be replaced by vasopressin 40 U IV/IO. Atropine 1mg IV/IO can also be considered q3-5min (up to 3 doses).

Sources: ACLS Guidelines; Wikipedia.