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Because hyperkalemia kills by either VT or VF arrest, or by bradycardia with PEA arrest, this should be assumed to be VT until proven otherwise. The arterial line bloodpressure immediately jumped from 80/40 with blunted monomorphic waveform to 140s/80s with bounding, normal-appearing waveform.
Compartment pressures in the right calf were all 40-50 mmHg. At that time his diastolic bloodpressure was also hovering between 45 and 55 mmHg. Upon arrival in the ICU, before getting Continuous Veno-Venous Hemodialysis (CVVHD), his potassium had risen again to 7.8
On arrival in the ED, he was hypotensive with a systolic bloodpressure in the 70s. He was admitted to the ICU and transferred emergently to a facility where he could undergo emergent dialysis as a part of further evaluation and management. Fluid resuscitation was initiated. Here is the initial ED ECG: What do you think?
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