case_images: PMC5977411_01
case_images: Initial EKG taken as patient arrived. EKG Interpretation: Wide complex tachycardia, concerning for polymorphic ventricular tachycardia. Ventricular rate at 165 BPM, QRS duration prolonged >150 msec.
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case_images: PMC5977411_01_gr1.jpg
case_images: fig0005
case_images: At this time, an initial EKG (Fig. 1) was taken, which showed a wide complex tachycardia closely resembling ventricular tachycardia (VT).
case_images: EKG taken post 1 ampule of sodium bicarbonate. EKG Interpretation: Narrowing of QRS intervals is seen, rhythm appears regular, tachycardic, ventricular rate at 153 bpm, QRS prolonged 156 msec, QTc prolonged 619 msec. This EKG shows the immediate effect sodium bicarbonate had in controlling our patient's wide tachy-arrhythmia.
case_images: gr2.jpg
case_images: PMC5977411_01_gr2.jpg
case_images: fig0010
case_images: A repeat EKG was obtained (Fig. 2), and showed some narrowing of her previously widened QRS. Her telemetry strip showed a narrowing of her previous ventricular tachycardia back to a strip similar to Fig. 2.
case_images: Roughly 5-10 min post intubation, post 2 ampules of sodium bicarbonate with a sodium bicarbonate drip running. EKG Interpretation: Wide complex tachycardia, concerning for Torsade's like morphology vs sine wave. Ventricular rate 186 bpm, QRS prolonged >150 msec.
case_images: gr3.jpg
case_images: PMC5977411_01_gr3.jpg
case_images: fig0015
case_images: Post intubation, the patient was given another ampule of sodium bicarbonate, with a subsequent bicarbonate drip (containing 100mEq of sodium bicarbonate), rectal acetaminophen was ordered, and a nasogastric tube (NGT) was attempted while a third EKG was being obtained (Fig. 3). The NGT was reattempted, however patient's telemetry rhythm strip at this time widened again to resemble Fig. 3 and she subsequently lost pulses again, and thus the NGT was aborted yet again to restart CPR, defibrillation, with more rounds of both epinephrine, sodium bicarbonate, and calcium before ROSC was regained.
case_images: Taken after 5th arrest with successful ROSC. EKG Interpretation: Ventricular rate 115 bpm, QRS narrowed at 128 msec, QTc mildly prolonged at 478 msec, PR interval prolonged at 170 msec. Sinus tachycardia, regular rhythm, QRS narrowed, nonspecific T wave inversions.
case_images: gr4.jpg
case_images: PMC5977411_01_gr4.jpg
case_images: fig0020
case_images: Another EKG (Fig. 4) was taken which showed a stable narrow rhythm.