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Code Blue

UnFiNiShEd CaSe CoMe BaCk LaTeR

“BRADY” DOWN FOR THE REST

You respond to a code blue in the ICU to find an intubated ICU patient with a team of nurses and are told she just had a a v-fb arrest and came back with epi x 1 and defibrillation x 1.  BP is OK.  She has sinus tach at 109 on the monitor.  You ask for recent lab results and are told the K was 3.2 (a bit low) and the Mg 1.7 (normal).  You ask to see the most recent EKG.

Initial EKG (low resolution):

COMPUTER EKG READ:

  1. Sinus rhythm
  2. Nonspecific T-wave abnormality

Do you agree with the computer?  What should you do next?

“BRADY” DOWN FOR THE EKG ANALYSIS & 1-MINUTE CONSULT

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EKG ANALYSIS, CASE OUTCOME, 1-MINUTE CONSULT & CASE LESSONS: 

1) EKG analysis (check out more great EKG’s from Dr. Stephen W. Smith of Dr. Smith’s ECG Blog): The computer read is incomplete.  It misses an obvious prolonged QT interval and actually measured it as borderline normal when it is quite prolonged.  The QTc was read by computer as 483, but it is obviously prolonged by the 1/2 RR rule of thumb.

2) Case Conclusion:    The “V-fib” the nurse states she saw when the patient went pulseless was captured and is shown below.  It looks like torsades

I recommended repleting potassium to level >4.5 and magnesium to level >2.5

 

3) 1-Minute Consult (from the Emergency Medicine 1-Minute Consult Pocketbookon the topic for this case:

4) Case Lessons: 

  1. Always check the QT yourself
  2. Never
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