ESRD dysrhythmia meds

Household6

Household6

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What does ALS administer to stabilize ESRD heart dysrhythmia in the field? It's beyond my scope, so my textbook doesn't list the meds. I'm just curious.

TIA!!
 
Think it through a bit. What ion is going to become increased that causes that most problems. Now out of our drugs that we carry, how can we protect the heart from it and the move it back into the cells and hide it from the system?
 
Corky said:
Think it through a bit. What ion is going to become increased that causes that most problems. Now out of our drugs that we carry, how can we protect the heart from it and the move it back into the cells and hide it from the system?
Click to expand...

Ummmmmm.. Potassium? High level of K cause the funky rhythm? Would they mean that it would cause a high level of acid in the blood? So you would combat acidosis with a base like sodium bicarbonate?

Don't mock me too badly if I'm wrong, I'm just a piddly EMTB right now -- My pharm skills are pretty limited.
 
Household6 said:
Ummmmmm.. Potassium? High level of K cause the funky rhythm? Would they mean that it would cause a high level of acid in the blood? So you would combat acidosis with a base like sodium bicarbonate?

Don't mock me too badly if I'm wrong, I'm just a piddly EMTB right now -- My pharm skills are pretty limited.
Click to expand...

Ding Ding Ding on choosing potassium. You're correct that there is often a correlation between hyperkalemia and acidosis. In these patients however, acidosis isn't their primary concern. Severe hyperkalemia is more often the cause of the dysrhythmias to which you referred, and we (well, most of us) carry something else to help protect against these issues.

Hint: Think about another electrolyte...

Bonus question!
How else is hyperkalemia managed in hospital, and what other drug can we potentially try pre-hospital that you wouldn't normally think of for cardiac rhythm issues?
 
chaz90 said:
Bonus question!
How else is hyperkalemia managed in hospital, and what other drug can we potentially try pre-hospital that you wouldn't normally think of for cardiac rhythm issues?
Click to expand...

Extra cookie if you can explain how this drug works in HyperK :P
 
chaz90 said:
Ding Ding Ding on choosing potassium. You're correct that there is often a correlation between hyperkalemia and acidosis. In these patients however, acidosis isn't their primary concern. Severe hyperkalemia is more often the cause of the dysrhythmias to which you referred, and we (well, most of us) carry something else to help protect against these issues.

Hint: Think about another electrolyte...

Bonus question!
How else is hyperkalemia managed in hospital, and what other drug can we potentially try pre-hospital that you wouldn't normally think of for cardiac rhythm issues?
Click to expand...

Calcium is the answer to the first. It functions using a cardio protective mechanism

And albuterol works wonders on hyperk.

Although one of the biggest things about treating hyperk is treating the underlying cause of the condition (DKA, etc).

STXmedic said:
Extra cookie if you can explain how this drug works in HyperK :P
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Ugh if I wasn't typing from an iPad I would. But I'm lazy today lol
 
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Damnit JT! That was for household to work through! :lol:
 
Yous guys realize I'm going to be retaining this information for the rest of my life because of the way you've made me figure it out, right? Thanks

chaz90 said:
Ding Ding Ding on choosing potassium. You're correct that there is often a correlation between hyperkalemia and acidosis. In these patients however, acidosis isn't their primary concern. Severe hyperkalemia is more often the cause of the dysrhythmias to which you referred, and we (well, most of us) carry something else to help protect against these issues.

Hint: Think about another electrolyte...

Bonus question!
How else is hyperkalemia managed in hospital, and what other drug can we potentially try pre-hospital that you wouldn't normally think of for cardiac rhythm issues?
Click to expand...

STXmedic said:
Extra cookie if you can explain how this drug works in HyperK :P
Click to expand...

Uhh... Well... I suppose I would guess a diuretic of some kind since ESRD patients retain fluids? And I would assume it's those fluids that are full of K?

Where did this calcium come from, now? Is it because Ca and K bind? I was going to guess Epinepherine instead of Albuterol because it's a vasodilator.

Ummm.. The only way I can think of to get rid of Ca is Vitamin D, but I didn't think that was used in emergency medicine..

TransportJockey said:
Lol let's see if he can answer your question too.
Click to expand...

I'm a girl, ese'..
 
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Household6 said:
Uhh... Well... I suppose I would guess a diuretic of some kind since ESRD patients retain fluids? And I would assume it's those fluids that are full of K?
Click to expand...
Most potassium in a healthy patient is filtered out in the kidneys, so thats a good thought process. Considering the patient is on dialysis- depending on the amount of kidney function left, a diuretic would be at best minimally effective.

TransportJockey already beat you to it. Albuterol is the medication not often considered, but effective and carried on the ambulance. Any thoughts to why that is?

Where did this calcium come from, now? Is it because Ca and K bind? I was going to guess Epinepherine instead of Albuterol because it's a vasodilator.*

Ummm.. The only way I can think of to get rid of Ca is Vitamin D, but I didn't think that was used in emergency medicine..
Click to expand...
You don't want to get rid of the Calcium, you actually want to give them more. Calcium helps stabilize cardiac cellular membranes, ideally preventing any arrhythmias.

*Neither of those medications is a vasodilator.
 
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Household6 said:
Yous guys realize I'm going to be retaining this information for the rest of my life because of the way you've made me figure it out, right? Thanks

Uhh... Well... I suppose I would guess a diuretic of some kind since ESRD patients retain fluids? And I would assume it's those fluids that are full of K?

Where did this calcium come from, now? Is it because Ca and K bind? I was going to guess Epinepherine instead of Albuterol because it's a vasodilator.
Click to expand...

Good thought on using a diuretic, but now you have to be really careful. A loop diuretic like Furosemide that promotes excretion of potassium isn't a bad idea and can be used, but you can't use a potassium sparing diuretic like Amiloride.

Calcium ions change the membrane potential (by virtue of having a 2+ valence electron shell charge) and allow increased K+ transit back into the cells. Keep in mind the much greater Ca++ ion accessibility with Calcium Chloride rather than Calcium Gluconate here, even though either can be used. Epinephrine in cases of HyperK induced arrhythmias would be a Bad Thing. I'll let you scour the literature for how albuterol helps. Also, insulin.
 
STXmedic said:
Albuterol is the medication not often considered, but effective and carried on the ambulance. Any thoughts to why that is?
Click to expand...

Welllll... Albuterol creates smooth muscle relaxation through beta-2 receptors...

It can lower blood sugar because it stimulates insulin production..

I'm trying to figure if insulin production is helpful to hyper K --without Googling)
 
chaz90 said:
Good thought on using a diuretic, but now you have to be really careful. A loop diuretic like Furosemide that promotes excretion of potassium isn't a bad idea and can be used, but you can't use a potassium sparing diuretic like Amiloride.
.
Click to expand...

I'm going to put those two on my "to-learn" list of pharmas.. Thanks, I don't know them yet.
 
Will K bind to insulin like glucose and get pushed into the cells?
 
Household6 said:
Welllll... Albuterol creates smooth muscle relaxation through beta-2 receptors...

It can lower blood sugar because it stimulates insulin production..

I'm trying to figure if insulin production is helpful to hyper K --without Googling)
Click to expand...

Beta2 adrenergic stimulation does cause bronchodilation. Epi and albuterol both have this effect. It doesn't effect the smooth muscle in the vasculature the same way, though.

Bingo on the insulin release! Insulin cause an intracellular potassium influx :D

Management of hyperK:
1) Stabilize the membranes- calcium
2) Redistribute potassium back into the cells- Insulin, albuterol, sodium bicarb
3) Get rid of excess potassium- Dialysis, kayexelate (sort of)
 
Now that you understand it somewhat go to emcrit.org and listen to Dr. Weingarts lecture on hyperk. Wanted you to do some researching on your own before I just handed over the site
 
This was great, guys. Thanks..

I feel like a need a cigarette after this.. :rofl:
 
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