Resolution of Left Bundle Branch Block After Calcium Administration in the Prehospital Setting
Phillip Bonar1, Marshall A Frank2
1Emergency Medicine, Florida State University College of Medicine, Sarasota, USA.
Insights
Hyperkalemia, a medical emergency, can present with electrocardiogram (ECG) changes like left bundle branch block (LBBB). Prompt treatment with calcium chloride resolved LBBB in a prehospital setting, highlighting ECG
Area of Science:
- Cardiology
- Emergency Medicine
- Nephrology
Background:
- Hyperkalemia is a critical condition requiring prompt recognition and treatment.
- Electrocardiogram (ECG) changes are vital for diagnosing hyperkalemia, especially in prehospital settings.
- Common ECG findings include peaked T-waves, PR prolongation, and QRS widening.
Observation:
- A case report details a prehospital ECG revealing a left bundle branch block (LBBB).
- The patient had end-stage renal disease, a condition often associated with hyperkalemia.
- Treatment with calcium chloride in the prehospital setting led to LBBB resolution.
Findings:
- Left bundle branch block (LBBB) can be an ECG manifestation of hyperkalemia.
- Prehospital identification and treatment of hyperkalemia-induced LBBB are feasible.
- Serum potassium level was confirmed at 6.1 mEq/L post-treatment.
Implications:
- Recognizing LBBB as a potential sign of hyperkalemia can expedite life-saving treatment.
- ECG interpretation in prehospital care is crucial for managing emergent conditions like hyperkalemia.
- This case underscores the importance of considering hyperkalemia in patients with new-onset LBBB, particularly those with renal disease.
Abstract:
Hyperkalemia is a medical emergency with potentially severe consequences that can be avoided by early recognition and effective treatment. Electrocardiogram (ECG) changes can help elucidate hyperkalemia prior to obtaining lab results and assist in early decisions on treatment, especially in the prehospital setting. ECG changes commonly associated with hyperkalemia are peaked T-waves, PR prolongation, P-wave flattening, QRS widening, or a sine-wave pattern at severely elevated potassium levels. Bundle branch blocks (BBBs) are associated with hyperkalemia but are less common and less well known in this setting. We report a case of a prehospital ECG showing a left bundle branch block (LBBB) in a patient who had end-stage renal disease, and the prehospital treatment with calcium chloride lead to resolution of the LBBB. The patient was eventually found to have a serum potassium level of 6.1 mEq/L.
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