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The T-waves in this patient are highly irregular. May be fused P waves or U waves or both. Definitely not hyperkalemia. May be hypokalemia. Has the patient been having diarrhea? On diuretics?
May also be fused P wave and now were back to BrushOkie's heart block (probably Stage 1).
What are the chances of both hypokalemic and stage 1 heart block?
Will IV KCL (bolus, 1100 mg) be differentiating? If so I would monitor the T waves to see if a normal T wave appears. If not then we may be dealing with heart block and IV lidocaine (50 mg IV bolus) would be indicated.
I am still leaning more towards AF with hypokalemia.
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