Torsades de Pointes

The first 10 minutes of emergency medicine resuscitation of torsades de pointes

Case

A 46 year old female is referred into the emergency department after multiple syncopal episodes. Her family physician did blood work and found her to be hypokalemic. She is on venlafaxine for depression and amitriptyline for sciatica. She is currently on a course of moxifloxacin for her sinusitis and this morning took a dose of fluconazole for the resultant candidiasis. On arrival, she is alert and looks well. However, as the ECG is being performed, she slumps over and you see:

ECG52105_3_hypoK.jpg

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Thyroid storm

The emergency department management of severe, decompensated hyperthyroidism

Case

A 45 year old woman with a past medical history of hyperthyroidism is brought into the emergency department by her partner. She has had urinary tract symptoms for the last 2 days, but now she looks really sick. She has been having diarrhea and crampy abdominal pain. She is having a hard time concentrating, is tremulous, and drenched in sweat. Her vital signs at triage include an irregular heart rate of 142 and a temperature of 39.5 degrees celsius. Continue reading “Thyroid storm”

Management of life-threatening hyperkalemia

A brief guide to the immediate management of severe hyperkalemia in emergency medicine and critical care

Case

An 82 year old man with a history of end stage renal disease, hypertension, coronary artery disease, and prior admissions for hyperkalemia is brought in by EMS with a history a 3 days of nausea, diarrhea, and fatigue, culminating in a witnessed collapse and a brief bout of bystander CPR. When the paramedics arrived on scene, he had a weak pulse and was only responding to painful stimuli. The ECG en route revealed a very strange appearing wide complex bradycardia, almost like a sine wave, and a VBG reveals a K+ of 9 mmol/L…

First10EM Hyperkalemia ECG K9.9 from Life in the Fastlane.jpg

#FOAMed Medical Education Resources (LITFL) / CC BY-NC-SA 4.0


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