Hook

you're the ICU doctor on call and ER admitted a bradycardia patient to your unit. But the nurse calls you and says, hey doc, this patient's potassium is 8.1. You run to the patient's bedside. He was just brought up from the ER when the ER doctor called you about this patient. You were told that he was bradycardic in the 30s. So they started some dopamine. His blood pressure was fine and he was now asymptomatic. Initially, he presented with some presyncope and one syncopal episode that prompted him to come to the ED. Now when you see him in the ICU, he's become tachycardic. Now he's in the 130s, 140s and his rhythm looks like this. He's still talking to you, he's mentating quite well. His blood pressure is still stable in the 120s and so you get a better history. And when you ask him what's happened, he tells you he's got a past medical history of hypertension, diabetes and end stage renal disease. He's on regular dialysis and he tells you that his last dialysis was about five days ago. You ask him if anything's changed, if he's had recent infections, any changes in his diet. He says, well, nothing's really changed. I do eat about five oranges a day though though. The ICU nurse now just completed putting the pads on him and they're looking at you and they're like, so what are we doing next? What's the exact next step for this patient, given the rhythm and given his potassium of 8.1, that's gonna get him better the fastest.
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