Hyperkalemic Bradycardia

A 26-year-old male was admitted to the casualty department of a local hospital 24 hours after being run over by a truck. The patient presented with altered consciousness, extensive crush injuries to the lower limbs, and signs of neurologic impairment. On examination, the patient had a blood pressure of 90/60 mmHg, a heart rate of 46 beats per minute and a Glasgow Coma Scale (GCS) score of 10/15. His electrocardiogram (ECG) revealed an abnormally tall peaked P wave and bradycardia (Figure 1). Laboratory investigations showed a serum creatinine level of 4.5 mg%, serum potassium level of 7.1 mEq/L, and creatine phosphokinase (CPK) level of 36,000 IU/L.