Indeed, withholding calcium during hyperK+ due to the possibility of an interaction with digoxin is probably negligent these days. I lobbied (successfully) to have it removed from our protocols many years ago.
I give CaCl without labs. I usually do not give bicarb, but if we are lucky enough (hello horrible vascular access patients) to have a second line I will. I rarely get to Albuterol.
I like that.
Our protocol is 1G calgl slow IV push and 1600mcg salbutamol. We have been advised to steer clear of bicarb for the time being unless ordered by doc via patch.
Most important part to remember. There are lots of ecg changes associated with hyperkalemia; widening of the QRS, av dissociation, peaked t-waves, bradycardia, sine wave, and just overall bizarre morphology. But you can't reliably predict the K level off of that.
Looks likewhat we used to call AV Dissociation. Looks like there are some P waves in some of the leads.
The inverted t's and the breaks predict Coronary slow flow phenomenon. Weight does not effect the voltage through the heart cavities. Small calcifications build up in the vessels and find their way to the heart. They are small enough that they don't cause a total and complete blockage however they can fill with blood and break loose as blood clots. A coronary angiography with TIMI is used to definitively diagnose. Diseases of the lymphatic system (beta cells in particular) would account for the CSFP and the weight.
Well, I didn't post it in the scenario forum for a reason
I didn't pay close enough attention to what apparently was the actual problem. Dispatched for the chest pain, on scene he complains of TIA-like symptoms and his AFib being somewhat out of control... I did puzzle over the EKG and point out the possible electrolyte problem to hospital staff (who were pretty dismissive of that idea, until the labs came back anyways). But nothing about the call made me inclined to go down that route of questioning too deeply. And while the T waves on the EKG are concerning, it really doesn't look like it's as severe as it apparently was (as everyone is pointing out).
This thread had been dead for 7 years so I don't think a 6 month call back is still in play.
