electrolyte induced ekg changes
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Electrolyte Induced EKG
Changes
The EKG as a Instantaneous
Monitor of Critical Patients
The EKG as a Instantaneous
Monitor of Critical Patients
By Robert Ehrlich M.D. , F.A.C.C.
EKG Strips from American Academy of Pediatrics Silver Prize Winning Exhibition 1984
“The EKG as an Instantaneous Physiological Monitor”
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Basics
• The Transmembrane Potential Changesproduce EKG
• K+, Na+ and Ca++ Fluxes cause the
changes• Abnormalities in these produce definitive
changes in EKG instantaneously
• Cardiac Function correlate to changes• Predisposition to Arrhythmias correlate
• Rx show changes immediately
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Most Common Answer: V Tach
• Correct Answer:
– Wide Complex Tachycardia
• Ventricular Tachycardia Most Common in Adults
• Hyperkalemia
– Most common in critically ill pediatric
patients especially in infant non cardiac patient
– I presume this is cause in a noncardiac pediatric arrest
and very frequently in cardiac patients
Strip from an Adult with Ventricular Tachycardia
Notice in following EKG‟s same pattern with
HYPERKALEMIA
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Continuous Strip
lasting one
minute showing
immediate effect
of a Bicarb push
There is a beat
by beat
improvement
from
hyperkalemia
towards normal
Analysis on next
slides
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Chaotic rhythm with cyclic pattern becoming regular
cycle one cycle two cycle three
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Hyperkalemia being corrected by bicarb correcting
acidosis shifting K+ into cell reducing e/i ratio
QRS is wide T is tall and tented P not seen may be
in T because of prolonged PR interval
Second row pattern identical V-Tach seen earlier
First two rows about 10 seconds
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Next 4 Rows about 40 sec
Beat by beat improvement as QRS narrows and T wave
diminishes Possible P seen buried in T in last row
Voltage of QRS is variable sometimes increasing or
decreasing as in this case
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Classic HyperKalemia pattern of prolonged
PR interval Wide QRS T wave increase and
tented Normalizes as Insulin drives K+ into
cells. Glucose is to cover insulin
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Acidosis shifts K+ out of cells
Alkalosis shifts K= into cells
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Ca++ counters the effect of increasing K+
without directly changing K+ levels
This not only includes EKG changes but
functional improvement
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Hypokalemia
T wave diminishes
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Bundle Branch Block caused by hyperkalemia
corrected with NaBicarbonate
Beginning
End
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Normally ST segment duration is less than T wave
In clinical situations such as rapid correction of acidosis where hypocalcemia is likely
presume low Ca++ if ST is longer than T
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Monitor Strips
These were recorded but no action was taken.
Deterioration of patient should have been Rx „ed
at strip B
“ SURPRISE” Arrest occurred
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Summary and Conclusion
2 THE CHANGES PRODUCE EKG COMPLEX VERIATIONS
3 THE VERIATION OCCURS THE INSTANT SIGNIFICANT CHANGES OCCUR
4 IN SITUATIONS WHERE VERIATIONS CAN OCUUR RAPIDLY
THE CONTINUOUS EKG CAN MONITOR FOR THE CHANGES
5 THERAPY CAN BE BASED ON THIS AND RESULTS SEEN IMMEDIATELY
6 EKG STRIPS ILLUSTRATE THE CHANGES AND RAPIDITY
7 EXPERIENCE UTILIZING PROTOCOL WHERE EKG FINDINGS DETERMINED
FREQUENCY OF EMERGENCY DRUG ADMINISTRATION IN CARDIAC
ARRESTS SHOWED HIGH SUCCESS RATE ATTRIBUTED TO TIMELYDOSING
1 ELECTROLYTE CONCENTRATIONS EFFECT CARDIAC DEPOLARIZATION