Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.

11Aug/11Off

Littmann’s EKG Course: T Waves

  • 1-3mm upsloping ST depressions in V1-V6 with tall, symmetric T-waves is highly concerning for hyperacute proximal LAD STEMI.

    New Wellens LAD

    This EKG was taken prior to cath of a patient with a 100% proximal LAD lesion. Note the upsloping ST segments.

    • N Engl J Med 2008;359:2071-3       Heart 2009;95:1701-6
  • The T-waves in hyperkalemia are often simply narrow-based rather than tall.  Because of this, the computer software often "double counts" the heart rate.

    Hyperkalemia

    This patient has a K+ of 7.2. Note that the computer "double-counts" the heart rate.

2Aug/11Off

Hyperkalemia, Marine Envenomations, and SBO

  • In addition to the 1st line treatments of calcium, insulin-d10, bicarbonate and dialysis, effective treatment of hyperkalemia involves β2-agonists; 20mg albuterol nebulized over 10 minutes or terbutaline 0.5mg IV quickly drives potassium intracellularly.
  • Proper treatment of most marine envenomations, catfish being the most common, is hot water soaks for 30-90 minutes with good wound care and a quinolone or augmentin for 5 days.
  • CT abd/pelvis is only 92% sensitive for small bowel obstruction.  Keep an open mind if you have strong clinical suspicion.
    • Allon M. Hyperkalemia in end-stage renal disease: mechanisms and management. J Am Soc Nephrol. 1995;6(4):1134.
    • Allon M, Copkney C. Albuterol and insulin for treatment of hyperkalemia in hemodialysis patients. Kidney Int. 1990;38(5):869.
    • Carrette TJ, Cullen M, et al. 2002. Temperature effects on box jellyfish venom, a possible treatment for envenomated patients? Med J Aust. 177: 654.
    • Glenister KM, Corke CF. Infarcted intestine: a diagnostic void. Journal of Surgery 2004. 74:260