Episode 86 – Emergency Management of Hyperkalemia

This is 'A Nuanced Approach to Emergency Management of Hyperkalemia' on EM Cases. Of all the electrolyte emergencies, hyperkalemia is the one that has the greatest potential to lead to cardiac arrest. And so, early in my EM training I learned to get the patient on a monitor, ensure IV access, order up an ECG, bombard the patient with a cocktail of kayexalate, calcium, insulin, B-agonists, bicarb, fluids and furosemide, and get the patient admitted, maybe with some dialysis to boot. Little did I know that some of these therapies were based on theory alone while others were based on a few small poorly done studies. It turns out that some of these therapies may cause more harm than good, and that precisely when and how to give these therapies to optimize patient outcomes is still not really known...

Best Case Ever 49 – Post-Arrest Hyperkalemia

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....