T-Waves

Hyperacute T-waves are often the first manifestation of complete vessel occlusion; they are wide, bulky and prominent. Hyperacute T-waves are not necessarily tall, and small T-waves can still be hyperacute when paired with a low-amplitude QRS complex. De Winter T-waves represent LAD occlusion (a STEMI equivalent) requiring immediate revascularization. Previously inverted T-waves can appear normal and upright in […]

ECG Changes of Hyperkalaemia

Classic teaching of the chronological ECG changes of hyperkalemia include: Peaked T waves Prolongation of PR interval Widening QRS Complex Loss of P wave “Sine Wave” Asystole The order of ECG changes of hyperkalemia have been defined in the experimental setting, but no uniform order has been documented in animal models (Ettinger, Regan, and Oldewurtel […]

Adrenal Crisis

Adrenal crisis is a life-threatening emergency due to an acute deficiency of adrenocortical hormones, namely cortisol and aldosterone, which can be fatal if not diagnosed early and treated aggressively. Classically it presents as severe hypotension refractory to IV fluids and vasopressors. Diagnostic Criteria: Hypoglycemia Hyponatremia (<135mEq/L) Hyperkalemia (>5mEq/L) Non-anion gap metabolic acidosis Low bicarbonate (15-20mEq/L) […]

ACLS Revision: Hyperkalaemia

Learning Points: When a patient is bradycardic, especially if irregular, one must always think of hyperK and one must get a 12-lead ECG. One must recognize this pattern as hyperK Calcium’s effect is almost miraculous Slow atrial fibrillation implies an sick AV node, or one affected by electrolytes, ischemia, or medications/drugs.  Otherwise, the ventricular response […]

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