You are posted as an EMO on duty. You receive a call at 11:30 PM, regarding an unconscious patient who arrives in an ambulance after 15 minutes. On assessment, you barely feel the radial pulse. No evidence of trauma noted. SBP is 58 mm Hg. You note the following finding while ECG is carried out. Patient had the following USG film . Which electrolyte abnormality is likely to cause the above clinical scenario?

The patient has sinusoidal ventricular rhythm, which is due to electrolyte abnormality in above case. The patient has USG repo suggestive of CKD due to raised coical echogenicity. AV fistula in forearm is suggestive that patient undergoes dialysis but may have missed and landed up in hyperkalemia. As a pa of management, defibrillation and control of hyperkalemia is priority while emergency hemodialysis is being readied.