Muhamad Na'im B Ab Razak (jacknaim) is a fresh graduate Muslim Doctor from Universiti Sains Malaysia and waiting for the enrollment into the housemanship program. Ambitious in pursuing master program in emergency and traumatology medicine and loves to spent his free time joining humanitarian missions, writing and speaks as an amateur public speaker in motivation and comparative religion. [HOME]

ECG OSCE Quiz 1


Answer


1) ECG shows the feature of hyperkalaemia

a) Sinus rhythm

b) Heart rate is 60 b.p.m

c) Small P wave

d) Prolong PR Intervals, 7 small square (normal is 3-5 small square)

e) Broad QRS complex, 4 small box (normally not exceed 2 ½ small box)

f) Prolong QT Intervals (normally not more than 0.35-0.45s or more than half or R-R intervals

g) Tall, broad T Wave


2) Hyperkalaemia secondary to chronic renal failure.


3) Causes of hyperkalaemia can be classified as follow




Taken without any modification from “Hyperkalaemia, page 7.9, Sarawak Handbook of Medical Emergency 2nd edition”,


4) Management

a) Transfer patient to Red zone with cardiac monitoring

b) Secure the ABC; comatose patient may need endotracheal intubation.

c) Obtain blood investigation

i. ABG (look for evidence of metabolic acidosis)

ii. BUSE/creat to access level of potassium and renal condition. Hyperkalaemia is defined as serum potassium level more than 5.5 mmol/L. severe hyperkalaemia when potassium level more than 6.5 mmol/L. however, in acute setting, treatment should not delay because of waiting for BUSE result.

d) Stop immediately any offending drugs

e) Start cocktail for hyperkalaemia

i. 10 ml 10% IV calcium gluconate slow infusion for cardiac protection, second dose may be given if no ECG changes after 5 minutes

ii. Rapid acting insulin 10 U with 50 ml of dextrose 50% infused slowly for 30-60 minutes. In this patient, need higher dose of glucose (100-150 ml). Repeat the regimes 6-8 hourly.

f) Beta agonist, IV Salbutamol 0.5 mg in 15 minutes or 10 mg delivered via nebulizer

g) Give sodium bicarbonate infusion if there is moderate- severe metabolic acidosis, IV infusion 100-200 mmol/L in 15-30 minutes.

h) Look for any complication of chronic renal failure especially acute pulmonary edema or uraemic signs.

i) Consider hemodyliasis.

j) Close observation of vital sign.

k) Admit patient to medical wards for observation if stable. If not stable, transfer to Intensive care unit.


Reference

1) Hua Huat Soo, lee Gong Lau & Peng Hong Chew, “Sarawak Handbook of Medical emergency 2nd edition”, C.E Publishing, 2005

2) Shirley Ooi &Peter Manning, “Guide to the essentials in Emergency Medicine”, Mc Graw Hill, 2004

3) Steve Meek, Francis Morris, "ABC of Clinical Electrocardiography- Introduction. II—Basic terminology", BMJ Vol 324, 23 February 2002