This has to get more attention. The fact that hyperK could mimic ventricular rhythms was covered in paramedic school, but the importance of avoiding sodium channel blockade was not. I've been in EMS for 7 years, and it wasn't until an MCHD episode I heard recently that I was aware of just how serious this differential is. This should be beat into our heads just like continuous compressions or early defibrillation.
I work for MCHD and I must say its great to see others understanding the importance of hyperk recognition in an EKG and patient presentation because of our podcasts.
I have attempted Synchronize Cardioversion on this kind of pt before as a first year Paramedic. They didn't really touch on this in school. Great video.
As a young resident once I put a temporary pacemaker in a patient with hyperkaliemia who had a slow rhythm and wide QRS BEFORE drawing blood for potassium and ABG...Luckily for him and me, it turned down just fine, after administering some bicarbonate and calcium iv
I probably would have given amio too not counting the ms and seeing stable wide complex. So glad I ran into this presentation before I had a similar case. Thank you.
Great talk. But I'd like to point out that ACLS DOES consider E'lytes etc in their algorithm.... it's actually the first step after ABCD to look out for "reversible causes" Amio comes much further down. So ...ACLS - if done properly - won't kill your hyperK or acid patients. Still, great talk.
Absolutely. I also find it kind of wild that people are apparently initiating treatment of these hemodynamically stable patients without just getting a blood gas first!? If they're too unstable for you to wait for a gas, then you need to use DCCV immediately anyway.
Great lecture. I will note that the sick patients that might end up with such wide complex tachycardias (whether hyperK or VT) aren’t the normal people in the room... so not sure if calcium is 100% innocuous
I am a retired RN ( 40 year career) and at one time did critical care and taught ACLS. I just now came across your video regarding toxic and metabolic causes of wide complex tachycardia and found the information to be fascinating and informative. Thank you.
So in pinned pts when we see HyperK buildup and we can't get access, we give albuterol to counter the HyperK status for a bit. Can you use that same trauma algorithm for RRWCT pts just to hold them over while you get access and drugs set up? I'm curious if it's a deviation of protocol or would it be considered using the wrong protocol for the right reason? Strictly speaking, on a living pt of course
Do you have any source for amiodarone leading to asystole in hyperkalemia? Preferably a source that can be cited. I don't find any valid source for this.
@@1230sandrag Hi, er resident here. This is an extremely advanced topic. though the presenter made it look simple, its not simple. In fact, as he said, the current standard of care guidelines that drs are recquired to follow make no mention of a nuanced sitution such as this. So yes, its not just run of the mill med skl info
@@1230sandragFree continuing education is important. Not all of us are in med school. Some of us are nurses, or in my case, paramedics, etc. We have to read books and watch recorded lectures to obtain education past school. You say “not posting it on TH-cam” but where should it be posted? This is a recording from a lecture in a professional setting. And do you think that for those who have completed med school, they should not continue to learn? That’s an awful attitude and leads to the decay of doctors.
@@carltonmiller6701 Thanks, ER doc. I'm wondering do "Guidelines" these days operate as RULES, or do ER doctors who may decide to go outside the "Guidelines" to intervene according to their clinical judgement to possibly save a life in nuanced cases? Do those docs suffer terrible career consequences? Are doctors free enough to make such decisions?
Alma Matthu is HILARIOUS with these comments "What happens when you give calcium to somebody who's not actually hyperK?" 5:36 leading up to punchline 5:41 LOL "Who programs EKG machines?" 7:24 LOOOL
Is there not easy access to venous blood gases in American Emergency Medicine? Sodium bicarbonate is not harmless if the reason for their VT is hypokalaemia.
@@MRCleavelin this is a lecture for emergency department medicine, not pre-hospital. Resource limitations in the field do not apply. If the patient is unstable then shock. If the patient is stable enough for you to get an amiodarone infusion then you have time to run a gas.
Some protocols are actually implementing bicarb infusions as a makeshift hypertonic. Should pull fluid off the brain, rather than the other way around.
People watch out for amiodarone as it is fatal; my husband took it at 200mg and died as he developed pulmonary fibrosis-irreversible damage to the lungs. Get a second opinion when possible. My family and I are so devastated by such tragic event-losing a loved one because of deadly medications, it's so sad when they're supposed to help heal, not kill.
why do we follow acls vfib algorithm which includes amiodarone in a patient that has known renal failure, hyperkalemia that eventually turned into a Sine wave then vfib? I'm asking because if the sodium channels are inactivated by hyperkalemia why give a sodium channel blocker? The more I read about hyperkemic cardiac arrest (meaning patient demise on arrival to the ER, EKG gets worse. k is elevated) I wonder why it 100% contraindicated in hyperkalemic RRWCT but the literature says follow acls protocol if you have a pt in vfib? I am reading that cpr should be prolonged so there's time to correct the k level. even hook them up to hemodialysis to try to get rosc back....so why do we stop after 30 min?
This is scary that doctors aren’t getting taught this in school and have to go to a convention (or TH-cam) for this LIFE SAVING information. Guess that’s why it’s called, practice 🤷🏽♀️
its a "probe test". Bicarb is often disregarded in patient with K>5.0 because it wont decrease as significantly as combo of insulin, dextrose, and albuterol. however in this case a few amps will quickly lead us into our next course of action.
Why don’t change ACLS? Nice of you to talk about killing patients so haphazardly, really enforces my confidence in the medical profession. These are lives we are talking about. Not just statistics.
He is not in charge of the AHA, so he cannot change ACLS. He is one of the leaders in the fight for better, more thoughtful care in cardiology, along with people like Doctor Steven W Smith. You’re directing your anger in the wrong place, this guy has gotten so many of us into studying cardiology the right way. I have no doubt that his lectures have saved lives ♥️
Hey... show the EKG. I saw it for like 1 second. TH-cam people do not get to see the EKG. This video ends up being completely useless and without all this circumlocution, the video could be 3 minutes long and stop wasting people's time.
There are multiple EKGs shown after the 2 min mark. As TH-cam people we also have the good fortune of a pause button if something isn't shown for long enough.
![[MV] A leap of faith...ความเชื่อใจครั้งสุดท้าย (From "Petrichor the series")](http://i.ytimg.com/vi/U1piZH2CNXA/mqdefault.jpg)
I dream of being a resident under Mattu's supervision.
me too
I am a NP student also want to have a great teacher like him!
This should be seen by every paramedic
I saved a patient because of you. Thanks
That's 100% the best compliment to Dr Mattu as a teacher - knowing you put the knowledge he transmitted into a lifesaving action!!! 👍👍👍
This has to get more attention. The fact that hyperK could mimic ventricular rhythms was covered in paramedic school, but the importance of avoiding sodium channel blockade was not. I've been in EMS for 7 years, and it wasn't until an MCHD episode I heard recently that I was aware of just how serious this differential is. This should be beat into our heads just like continuous compressions or early defibrillation.
I agree!!! This was not brought to my attention until I was listening to a podcast and follpwing his ecg weekly subscription.
I work for MCHD and I must say its great to see others understanding the importance of hyperk recognition in an EKG and patient presentation because of our podcasts.
Every single word of this genius is pure gold
I have attempted Synchronize Cardioversion on this kind of pt before as a first year Paramedic. They didn't really touch on this in school. Great video.
Getting myself back into paramedicine.
Very, very good refresher. Thank you.
I do love you Mr Mattu. I love listening to you...you make ECG increasingly easy for me.
As a young resident once I put a temporary pacemaker in a patient with hyperkaliemia who had a slow rhythm and wide QRS BEFORE drawing blood for potassium and ABG...Luckily for him and me, it turned down just fine, after administering some bicarbonate and calcium iv
I probably would have given amio too not counting the ms and seeing stable wide complex. So glad I ran into this presentation before I had a similar case. Thank you.
Nice talk, this guys teaches others how to be better at saving lives 👏👏👏
i love this speaker 😂❤ my favorite teacher in this series.
Thank you for what you do. I always learn something from your presentations, and they are always entertaining as well!
Really enjoyed this lecture. Very helpful for those rhythms that may not have us sold that they are actually V-Tach!
This is absolutely brilliant, entertaining , exciting . What a Joy. I don’t have any other words.
I really like the concept of a treatment with the worst scenario outcome being patient's bones get stronger.
Thank you Doc.
Wow! Fantastic. Never knew this. Just added some valuable Pearls to my medical collection......
You are saving lives sir
You are awesome, May God reward you for that
Great talk. But I'd like to point out that ACLS DOES consider E'lytes etc in their algorithm.... it's actually the first step after ABCD to look out for "reversible causes"
Amio comes much further down.
So ...ACLS - if done properly - won't kill your hyperK or acid patients. Still, great talk.
Absolutely. I also find it kind of wild that people are apparently initiating treatment of these hemodynamically stable patients without just getting a blood gas first!? If they're too unstable for you to wait for a gas, then you need to use DCCV immediately anyway.
Lecture of outstanding quality 👌
I am glad some one so good in cardiology thinks and interprets ekg's like me. :D
Such a great piece of information. Never heard before.
Had the same case today thanks to this video,I picked it up ,gave gluconate instead. Potassium was 8.
You are a great teacher..!! Thanks a lot
I always chose propofol and 200 joules over cardizem or amiodarone. I mean for myself, presenting with atrial fib.
Thank you so much for this video! It was really enlightening!
Another awesome period of instruction. Thank you!
This video is excellent.
Great lecture. I will note that the sick patients that might end up with such wide complex tachycardias (whether hyperK or VT) aren’t the normal people in the room... so not sure if calcium is 100% innocuous
Nothing is innocuous of course.
But you have to balance risk vs benefit, specially in the acute setting.
Fantastic video .. Thank you so much..
Superb talk
Nice work........
Thank you for this sage advice. Primum no-kill-em!
Thank you again and again
Great teaching and superb teacher
I am a retired RN ( 40 year career) and at one time did critical care and taught ACLS. I just now came across your video regarding toxic and metabolic causes of wide complex tachycardia and found the information to be fascinating and informative. Thank you.
I am a NP student. Did you recall situations make mistake about this topic? Just curious
This is a physician I would love to do a residency with.
Thank you very much brilliant doctor
Brilliant. Magic. Thank you.
So in pinned pts when we see HyperK buildup and we can't get access, we give albuterol to counter the HyperK status for a bit. Can you use that same trauma algorithm for RRWCT pts just to hold them over while you get access and drugs set up? I'm curious if it's a deviation of protocol or would it be considered using the wrong protocol for the right reason? Strictly speaking, on a living pt of course
if you have query , it's better to email him personally. Here in comment section it's too much information to go through all of them
Thanks, Amal!!
Anna Marie Allen
Great information
Thank you very much, very useful lesson
Do you have any source for amiodarone leading to asystole in hyperkalemia? Preferably a source that can be cited. I don't find any valid source for this.
Great teaching
This isnt Ventricular Tachycardia, this is bordering on *“sine wave pattern”* which is a very well recognised EKG manifestation of hyperkalaemia.
Mortality rate is very high in ours emergency department.
This dude's too OP
Thank you!
OMG! You're scaring me. ERs seem to be very dangerous places for any patient.
Right!! It’s like they should be teaching this in Med school and not on TH-cam/some convention.
@@1230sandrag Hi, er resident here. This is an extremely advanced topic. though the presenter made it look simple, its not simple. In fact, as he said, the current standard of care guidelines that drs are recquired to follow make no mention of a nuanced sitution such as this. So yes, its not just run of the mill med skl info
@@1230sandragFree continuing education is important. Not all of us are in med school. Some of us are nurses, or in my case, paramedics, etc. We have to read books and watch recorded lectures to obtain education past school. You say “not posting it on TH-cam” but where should it be posted? This is a recording from a lecture in a professional setting. And do you think that for those who have completed med school, they should not continue to learn? That’s an awful attitude and leads to the decay of doctors.
If it is a true emergency, your chances are definitely better than just not doing anything lol.
@@carltonmiller6701 Thanks, ER doc. I'm wondering do "Guidelines" these days operate as RULES, or do ER doctors who may decide to go outside the "Guidelines" to intervene according to their clinical judgement to possibly save a life in nuanced cases? Do those docs suffer terrible career consequences? Are doctors free enough to make such decisions?
great info.
superb teacher
Amazing!
That was awesome
Thanks!
excellent
i wanna be a student of amal mattu
Fantastic 👌🏻👏🏻
Alma Matthu is HILARIOUS with these comments
"What happens when you give calcium to somebody who's not actually hyperK?" 5:36 leading up to punchline 5:41 LOL
"Who programs EKG machines?" 7:24 LOOOL
Wonderful 🎉
Thank you sir.
I sea the Video on 2023 thanks a lot for this information
I didn’t hear the dose of ca or bicarbonate can any one mention it please
Don't they do blood gases in US?
Amazing... Genius indian
But why is that pt so tachy in that case?
Is there not easy access to venous blood gases in American Emergency Medicine? Sodium bicarbonate is not harmless if the reason for their VT is hypokalaemia.
@@michaelhoover500 agree, but again my question is: why aren't people just measuring the potassium on a VBG?
Some services are able to draw and interpret labs in the field via I-stat but it is not common practice.
@@MRCleavelin this is a lecture for emergency department medicine, not pre-hospital. Resource limitations in the field do not apply.
If the patient is unstable then shock. If the patient is stable enough for you to get an amiodarone infusion then you have time to run a gas.
excellent new knowledge for me. thanks to god i didn't commit clean kill before ^_^
What kind of calcium? Calcium chloride?
Can do that or gluconate. Just have to give 3 times as much calcium gluconate (ie. 3 amps instead of 1 amp).
Won’t bicarbonate’s 2 ampules will lead the pt towards brain edema?
Some protocols are actually implementing bicarb infusions as a makeshift hypertonic. Should pull fluid off the brain, rather than the other way around.
Not sure if you still look at the questions on here. If you cardioverted this gentleman would he have responded to that, given that it was hyperK?
B C I’ve had them convert, but only briefly. Until you fix the K, they’ll just keep going back into it.
Calcium chloride or calcium gluconate?
Either. Difference is just the dosing and possible complications
People watch out for amiodarone as it is fatal; my husband took it at 200mg and died as he developed pulmonary fibrosis-irreversible damage to the lungs. Get a second opinion when possible. My family and I are so devastated by such tragic event-losing a loved one because of deadly medications, it's so sad when they're supposed to help heal, not kill.
why do we follow acls vfib algorithm which includes amiodarone in a patient that has known renal failure, hyperkalemia that eventually turned into a Sine wave then vfib? I'm asking because if the sodium channels are inactivated by hyperkalemia why give a sodium channel blocker? The more I read about hyperkemic cardiac arrest (meaning patient demise on arrival to the ER, EKG gets worse. k is elevated) I wonder why it 100% contraindicated in hyperkalemic RRWCT but the literature says follow acls protocol if you have a pt in vfib? I am reading that cpr should be prolonged so there's time to correct the k level. even hook them up to hemodialysis to try to get rosc back....so why do we stop after 30 min?
This is scary that doctors aren’t getting taught this in school and have to go to a convention (or TH-cam) for this LIFE SAVING information. Guess that’s why it’s called, practice 🤷🏽♀️
Another good landmark could be: wide QRS kompl and a patient talking to you, with normal bp makes v tach unlikely.
You arent seriously denying the existence of pulsed VT are you? It's far from rare.
two amps you mean two ampoules ??
Watching in 2022
07:19 🏆💖
Clean kill?
What did he say? "Who programs the ecg machine? ... " I didn't understand it
Plaintive attorneys 😂😂
You r right
No harm in giving hco3, apart from getting severe hypokalaemia!!!! Get a vbg first...
Stupid response. Time delay and HCO3 amount not taken into consideration. Fail...reason...arrogance....advice...try another field.
Bicarb will not drop your K quickly enough to cause any clinically significant hypokalemia, even if your initial K is normal to begin with.
its a "probe test". Bicarb is often disregarded in patient with K>5.0 because it wont decrease as significantly as combo of insulin, dextrose, and albuterol. however in this case a few amps will quickly lead us into our next course of action.
@@MeAjudaAiPO best give first calcium gluconate and GI DRIP 25% dextrose 10 human actrapid insuline drastically drop k potassium
Why don’t change ACLS? Nice of you to talk about killing patients so haphazardly, really enforces my confidence in the medical profession. These are lives we are talking about. Not just statistics.
He is not in charge of the AHA, so he cannot change ACLS. He is one of the leaders in the fight for better, more thoughtful care in cardiology, along with people like Doctor Steven W Smith. You’re directing your anger in the wrong place, this guy has gotten so many of us into studying cardiology the right way. I have no doubt that his lectures have saved lives ♥️
Hey... show the EKG. I saw it for like 1 second. TH-cam people do not get to see the EKG. This video ends up being completely useless and without all this circumlocution, the video could be 3 minutes long and stop wasting people's time.
There are multiple EKGs shown after the 2 min mark. As TH-cam people we also have the good fortune of a pause button if something isn't shown for long enough.
Pause the video dummy
HMM NOT VERY CONVINCED
You are joking, ehh?
You may be smart info to use the internet, but it doesn't mean you should.