Slide 1: 80yo M. HR=35. BP=90/30. [EKG] What’s your next step?

Slide 2: Atropine given without response. Pacer pads placed. What’s your Rx?

Slide 3: 2g calcium gluconate (Yes, we’re talking hyperkalemia!)

Slide 4: Don’t see it? Let us help! [EKG shows absent P waves and widened QRS complex (RBBB escape rhythm)]

Slide 5: Post-treatment EKG. [EKG] Of note: The long PR (present after treatment) is due to chronic 1st degree AV Nodal block!

Slide 6: The Take Home. The Ddx: For bradycardia, one must get an EKG And consider hyperkalemia. The findings: Usually peaked Ts, PR lengthens, sinus arrest, wide QRS with conduction block and sine wave before a terminal rhythm. The Rx: The most important treatment is calcium gluconate. The response is instantaneous.

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