A 57-year-old male patient is admitted to the ICU with urosepsis secondary to an obstructed urinary tract. He is haemodynamically stable with no chest pain. His ECG is shown on page 14 (ECG 30.3).
a) What is the most likely diagnosis, and the immediate pharmacological therapy? (20% marks)
The already challenging process of finding ECGs which the college remove from their published papers (so they can re-use them) has been rendered even more challenging in the Cursed Second Paper of 2020 which was returned to the candidates without any official answers. Fifty seven? UROSEPSIS? What the hell could this mean? The imagination runs wild. Surely, you think to yourself, this must have been some kind of electrolyte abnormality which gives rise to urinary calculi as well as to a clearly obvious ECG abnormality, and which has some emergency pharmacological treatment? Hypercalcemia fits that description. This ECG from the Atlas of Electrocardiography via LITFL has a shortened QT interval, which is characteristic of this condition. Bisphosphonates, calcitonin and IV hydration would be the immediate pharmacological steps.