Hyperkalemia
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 1 January 2017
⏱️ 10 minutes
🧾️ Download transcript
Summary
Hyperkalemia = EKG… EKG changes = Calcium…
Step 1: Recheck the Potassium
* Most common cause of hyperkalemia is PSEUDOhyperkalemia* Caused by too aggressive/fast of a blood draw* Causes RBCs to break open and falsely increase serum potassium
Step 2: Get an EKG
* Earliest EKG change* Peaked T waves* Late EKG changes* Flattened P wave* Prolonged QRS* Critical/Emergent EKG changes* Sine wave
Step 3: Protect the Heart
* EKG Changes = Give Calcium* Calcium gluconate (can be given IV)* Stabilizes the myocardium against dysrhythmia
Step 4: Shift Potassium Into Cells
* Insulin (plus D50)* Albuterol
Step 5: Remove Potassium from Body
* Kayexalate* Notorious for causing intestinal necrosis* Falling out of favor* Furosemide
Additional Reading
* Round 8 – Fall (EM Clerkship)* Emergency Management of Hyperkalemia (EM Cases)
Transcript
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| 0:00.0 | Hello, med students. |
| 0:02.3 | My name is Zach Olson, and thank you for downloading this episode of the EM Clerkship |
| 0:08.2 | Podcast. |
| 0:09.9 | We have a huge case today. |
| 0:14.0 | This is big. |
| 0:14.9 | This is a really important topic. |
| 0:17.4 | Let's get started. |
| 0:20.2 | Okay. Let's get started. |
| 0:29.4 | Okay, everybody got a 26-year-old females and marathon runner coming from the race today. |
| 0:36.8 | Arrived at the medical tent, complaining of chest pain, chest palpitations, and tingling in fingers, both hands. |
| 0:41.4 | Has a history of diabetes, does have a pump. BP of 160 over 90 pulse of 110 respirations of 20 glucose was at 80 EKG was showing peak T waves and arrhythmia and the med tent had a nice sat on scene and showing in potassium of 6.5 |
| 0:51.0 | we have two 18 gauge IV locks in the right and left AC. Icebacks under both arms |
| 0:55.6 | and the groin. The temp was 102 and a half as of five minutes ago. |
| 1:09.0 | Hyper Kaleemia. |
| 1:13.5 | I know electrolytes are boring. |
| 1:17.4 | Electrolites are like my least favorite topic probably in all of medicine, |
| 1:21.4 | but you at least need to know about hypercalemia. |
| 1:24.4 | Hypercalemia is one of our critical diagnoses. |
| 1:31.1 | And the one thing that I want you to remember today is hypercalemia equals EKG. And EKG abnormalities equals calcium. If you only remember one thing today, that's what it is. |
| 1:41.3 | Hypercalemia equals EKG and EKG abnormalities equals calcium. That will save a life. |
| 1:50.0 | You need to know that. Now before we get started with our whole approach, what causes hyper |
| 1:55.6 | calemia? We know it's deadly. It's really, really deadly, actually. But why do people get hypercalemia? |
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