[Cusom27] Correction on EKG from Autonomic Cases!

[Powers, James E]

Hi again Class of 2027!

Sorry to bug you with another email but when I was reviewing the slides to put together your study guide, I immediately realized that we actually mis-identified the 12-lead EKG associated with the 2nd case (organophosphate poisoning).  I think I was just too excited and having too much fun 🙂

So, in class I believe the rhythm was identified as sinus bradycardia with the presence of a u-wave following the t-wave.  However, on closer inspection, you can see that what resembled a u-wave is actually a p-wave.  It has the same morphology as the p-wave and it "marches out" with a constant p-p interval across the rhythm strip (see image below).  That means there are more p-waves than QRS complexes and the p-waves that do conduct have a constant PR interval.  As such, this is actually a Second Degree HB Type II (Mobitz II) with a 2:1 block.

Sorry about that!  Please let me know if you have any questions!

Thanks again!

Dr. P

The blue lines represent p-waves that are conducting whereas the red lines represent p-waves that are blocked.

[cid:54a98a8a-06e8-4d34-bbd4-dca846b07e00]



Jim Powers, DO, FACEP, FAAEM
Associate Dean for Clinical Integration

Professor of Emergency Medicine
School of Osteopathic Medicine | Campbell University
jpowers at campbell.edu | 910.893.7209



[ature_1725627076]<http://medicine.campbell.edu/>

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