Did this call yesterday: 58 y/o male with long hx of renal failure and dialysis. Missed his last 2 dialysis appointments and was c/o SOB and weakness. Also, numbness and difficulty moving his arms and legs. GCS 15, pale with cyanosis and difficulty breathing (lungs clear). No radial pulses but got a weak brachial at a rate of about 25bpm. Unable to obtain a BP or Spo2. BGL 11.3 mmol/L. Gave high flow O2 initially and then started nebulizing Ventolin once I got a hx and saw the 1st ECG. We don't carry Calcium on car yet, unfortunately, but as you can see from the 2nd ECG his rate improved and the QRS narrowed noticeably. Also, he stated that his breathing was better and had better movement of his arms and legs. His K+ ended up being 9. I've never had a hyperkalemia pt before and was surprised to see the Ventolin work so well and so quickly. I though about pacing him but didn't because he improved with the neb, and I'm not sure if pacing would have worked anyway. I also didn't feel that IV fluids (NS) would be beneficial so I just put in a saline lock. Is there anything else I could have done or maybe something I could have done differently?