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Sharpen Your Calipers - Dr. Littmann

12/10/2015

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Picture
The Role of the ECG in Acute Nontraumatic BLE Weakness
 
Acute bilateral lower extremity paralysis
  1. The differential diagnosis of acute nontraumatic bilateral weakness is broad
  2. Most causes have unique manifestations and symptoms
  3. The two most common cluster of causes of acute nontraumatic BLE weakness without significant associated symptoms: spinal cord disease and periodic paralysis
  4. Patients with periodic paralysis have unique ECG manifestations
 
Hypokalemic periodic paralysis
I. Familial hypokalemic periodic paralysis
  1. Mostly Caucasian men
  2. First attack at age <25
  3. Most patients have family history
  4. Most patients have repetitive attacks
II. Thyrotoxic hypokalemic periodic paralysis
  1. Mostly Asian and Latino men
  2. First attack later (20s – 30s)
  3. Attacks only occur when hyperthyroid
  4. No family history of periodic paralysis
  5. Hyperthyroidism frequently indolent, easy to miss the diagnosis
III. Common ECG manifestations of thyrotoxic hypokalemic periodic paralysis
  1. Large distant U waves frequently reaching the next P waves
  2. Tall QRS complexes
  3. Slight PR prolongation
  4. Terminal notching of QRS complexes in anterior chest leads (rsR’ pattern)
IV. Emergency treatment of thyrotoxic hypokalemic periodic paralysis
  1. Propranolol
  2. Use caution with potassium replacement
 
Hyperkalemic paralysis
  1. Almost always acquired and/or iatrogenic
  2. Only occurs with severe, extreme hyperkalemia
  3. Wide bizarre QRS complexes, sine-wave appearance
  4. Usually no P waves present
  5. Most patients do not have PEA
 
ECG signs of severe hyperkalemia
  1. The more severe the hyperkalemia, the less you can expect peaking of the T waves
  2. Widened QRS complexes, new axis shifts
  3. Widened QRS complexes with ST-segment elevation in V1-V2
  4. Widened QRS complexes with the Brugada pattern in V1-V2
  5. Double counting of heart rate by the ECG interpretation software
  6. Sine-wave appearance


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  • RESIDENCY
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    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
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    • PGY-3
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  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction