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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
Basics
The Transmembrane Potential Changes
produce 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
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 EKGs same pattern with
HYPERKALEMIA
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
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
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
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
Acidosis shifts K+ out of cells
Alkalosis shifts K= into cells
Ca++ counters the effect of increasing K+
without directly changing K+ levels
This not only includes EKG changes but
functional improvement
Hypokalemia
T wave diminishes
Bundle Branch Block caused by hyperkalemia
corrected with NaBicarbonate
Beginning
End
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
Monitor Strips
These were recorded but no action was taken.
Deterioration of patient should have been Rx ed
at strip B
SURPRISE Arrest occurred
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 TIMELY
DOSING
1 ELECTROLYTE CONCENTRATIONS EFFECT CARDIAC DEPOLARIZATION