![]() ![]() The ventricular rate is around 35 bpm, and regular. The first thing that anyone should notice is the slow rate. The ECG: This ECG has something for your basic students, and even more for the more advanced learners. Unfortunately, we have no other information. 2006 33(1): 40-47.The patient: This ECG was obtained from a 91-year-old woman who was complaining of weakness. Treatment of hyperkalemia: something old, something new. Philadelphia, PA: Elsevier Saunders 2014. Admitted to CCU and underwent emergent HD x 1.Treatment in the ED: calcium gluconate x 2, insulin/glucose, albuterol x 3, furosemide, kayexelate x 2, pacer pads.Newer medications: Patiromer & ZS-9 (sodium zirconium cyclosilicate).Emergency interventions for hyperkalaemia. kayexelate) may reduce serum K+ ( Editor’s note: There is no evidence for efficacy in the ED, and there are documented cases of associated intestinal necrosis – most binding resins should no longer be considered part of ED management Mahoney B, et al. Furosemide induces kaliuresis in patients with renal function.Reduces serum K+ over 30 minutes, but potassium begins to re-enter the extracellular space over the next several hours.Insulin + D50, B-adrenergic agonist (note that the dose for hyperK is much higher than for asthma), sodium bicarbonate (if already acidemic).Ca++ helps to stabilize the cardiac membrane and makes the cardiac myocytes less excitable. ![]() But instead of atropine, the initial drug of choice is calcium: calcium chloride (1 amp or 10mL) or calcium gluconate (10-30mL). ![]() The exam shows that his mental status is intact but given his hypotension and recent falls, you should be reaching for the pacer pads in case he deteriorates further.
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