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A 75 year old female presents with nausea, vomiting for 1 day and has diffuse abdominal discomfort. She denies chest pain or shortness of breath. She has a PMHx of HTN, DM, and ESRD. Her glucose is 150. What does the initial EKG show? What treatment did you give to get to the second EKG? Rate: 30-35 Rhythm: slow, regular with no p waves, junctional Axis: left PR: no p waves QRS: wide (.12) ST: peak T waves EKG diagnosis: junctional escape rhythm Clinical diagnosis: hyperkalemia Treatment: calcium IV Sodium bicarbonate IV Glucose and Insulin IV Kayexalate If no response to the above, atropine and transcutaneous pacing may also be used. |