EKG Practice #4

Ray Fowler, MD is Professor of EM/EMS at UTSW/Parkland.
Edited by Alex Koyfman, MD

Case

A 67 year old woman with metastatic squamous cell cancer presents to the emergency department having been found on the floor by a family member. She lived alone and cared for herself and was apparently given to heavily imbibing in solutions containing two carbon fragments.

She was clearly quite ill, hypothermic, and confused. She was very weak and had difficulty moving her extremities. Her blood pressure was 95/55, and her temperature was 34 degrees centigrade. Her 12 lead ECG revealed this:
ekg1

A closer look at leads V1 through V3 is found here:

ekg2

What is your interpretation, and what do you think that this patient’s electrolyte panel would show?

2 thoughts on “EKG Practice #4”

  1. Hypercalcemia causes short QT and hypokalemia causes (apparent) long QT, so what’s her true QT in this case?

    Also it seems to me that this EKG is dominated by hypokalemic findings, I’m not sure what you mean by “missing ST segment”.

    Good case.

  2. Hypercalcemia causes short QT and hypokalemia causes (apparent) long QT, so what’s her true QT in this case?

    Also it seems to me that this EKG is dominated by hypokalemic findings, I’m not sure what you mean by “missing ST segment”.

    Good case.

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