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I completed my medical school and background EM training from India (Christian Medical College, Vellore and Apollo Hospitals, Hyderabad) where I worked for 4 years. Following this, I devoted (with all my heart) about 1.5 years to do US Medical Licensing Exams. My stint towards an EM Residency in States did not work but it took me to places and it has been quite a journey. I then relocated to London, England to work as a Registrar (Non-Trainee) in A&E. This gave me an opportunity to better understand NHS, EM training pathways and more importantly the EM Mindsets in the United Kingdom. 

Currently, I am pursuing Higher Specialist Training in Emergency Medicine at South East Scotland Deanery where I have the honour and privilege of training under some of the most innovative brains in the field of Emergency Medicine. Over the past few years, I have realised that LEARNING and UNLEARNING (which can be challenging!) is equally important to deliver cutting edge care to our patients.And through this blog, I aspire to disseminate knowledge, assist trainees with exams and stay up to date with contemporary EM literature. I have always been an avid FOAMed supporter because FOAMed has always played an indispensable role during my training. 

Lakshay Chanana
ST4 EM Trainee 
Edinburgh, Scotland

Monday, February 16, 2015

HyperK - Get the ECG

Hello friends

This week we are gonna talk about something which we come across in the ED almost everyday.

We all learned to look for the ECG changes for hyperK and also how the changes correlate with the levels of potassium.

K levels        ECG changes

5.5 - 6.5       Tall tented T waves
6.5 - 7.5       Loss of P waves
7.5 - 8.5       Widening QRS
> 8.5            Sine Wave pattern, Ventricular Arrythmias

Well, Don't waste your time in memorising these changes and the corresponding potassium levels. Patients don't read textbooks and they don't follow this textbook pattern of ECG changes.

A potassium of 8 may not produce any ECG changes and at the same time Ventricular Fibrillation can be the first ECG change in hyperK. So if they have elevated K which concerns you, just go ahead and give them some calcium regardless of ECG changes. And if they have ECG changes with hyperK, be more aggressive with the correction.

HyperK often comes up with strange rhthyms and I learned this pearl from the EKG Guru "Amal Mattu" --> "Any bizarre EKG changes, think hyperKalemia and try some calcium". Lets hear it from the EKG GOD himself.

Weisberg LS. Management of severe hyperkalemia. Crit Care Med. 2008 Dec;36(12):3246-51.

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