Best Case Ever 49 – Post-Arrest Hyperkalemia

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7 • 602 Ratings

🗓️ 13 September 2016

⏱️ 4 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

Melanie Baimel's Best Case Ever on Post-Arrest Hyperkalemia on EM Cases. Post arrest patients can sometimes be challenging. We need to think of a variety of underlying causes of the arrest, antiarrhythmics, possible cath lab activation, targeted temperature management, sedation and more. To add to this, many post arrest patients do not have ideal vital signs that require attention. In this Best Case Ever, in anticipation of our upcoming episode on A Rational Approach to Hyperkalemia Dr. Melanie Baimel describes a post arrest patient who remains bradycardic and hypotensive despite multiple pressors....

Transcript

Click on a timestamp to play from that location

0:00.0	Yes, this is E.MK's best case ever mini podcast series, and I'm your host, Dr. Anton Hellman.
0:29.6	It's my great pleasure to have back on EM cases, Dr. Melanie Bamele, from Sunnybrook Hospital in Toronto,
0:37.0	who was one of our guest experts on one of my
0:40.3	favorite podcasts that we've done on EM cases, the emergency management of hyponatremia.
0:46.2	Dr. Bamel, welcome back to EM cases for your best case ever.
0:51.0	Great. Thanks, Anton. So I have this great case of a 50-year-old male who presented in
0:56.6	cardiac arrest. No past medical history, he arrested in the car with his wife and was very
1:02.9	sudden an onset. CPR was started within five minutes of him losing consciousness. And he was
1:10.3	brought into our emergency room in PEA.
1:13.7	We did CPR and all the usual ACLS things and were able to obtain a return of spontaneous
1:20.5	circulation.
1:21.9	However, his heart rate was profoundly low.
1:26.2	He was in the 30s. His QRS complexes were wide and there were no
1:30.5	P waves. His blood pressure was also extremely low despite being on three pressers. And so we decided
1:38.9	to try and pace him. And unfortunately, the pacer wasn't capturing. And we kind of all scratched our heads.
1:47.0	And fortunately, cardiology arrived because, you know, we were concerned that the patient obviously
1:51.9	had suffered a primary cardiac event, like a big RCA infarct. And they suggested that we try
1:58.7	stabilizing his membranes with calcium and shifting him. And sure enough,
2:02.7	the PACER started to capture the QRS complexes. His heart rate came up and his blood pressure
2:08.7	improved and he was taken up to the cath lab and stented. All right. So all along, he may have well
2:15.5	had a huge MI, which can certainly cause bradicardia,
2:20.7	but he was also hyperk.
	...

Please login to see the full transcript.

Previous episode | Next episode

Disclaimer: The podcast and artwork embedded on this page are from Dr. Anton Helman, and are the property of its owner and not affiliated with or endorsed by Tapesearch.

Generated transcripts are the property of Dr. Anton Helman and are distributed freely under the Fair Use doctrine. Transcripts generated by Tapesearch are not guaranteed to be accurate.