Cardiac arrest in electrolye disorders Flashcards Preview

ALS > Cardiac arrest in electrolye disorders > Flashcards

Flashcards in Cardiac arrest in electrolye disorders Deck (10):
1

Potassium disorders

Acidaemia-serum potassium increases
aLKalosis-serum potassium is low

2

Hyperkalaemia
Definition and causes

>5.5
>6.5 is severe
Causes:

- Renal failure
- ACEi, AIIRB, potassium sparing diuretics, NSAIDs, beta blockers, trimethoprim
- Tissue damage
- Metab acidosis
- Addisons
- Diet in chronic renal replacement

3

Hyperkalaemia
Symptoms and signs

Weakness, flaccid paralysis, paraesthesia, areflexia

ECG changes:
- 1st degree block-prolonged PR interval
- Flattened or absent p waves
- Tall, peaked, tented T waves
- ST segment depression
- Widened QRS
- Bradycardia
- Ventricular tachycardia
- Cardiac arrest-all rhythms

4

Hyperkalaemia
Treatment

5.5-5.9
1) Calcium resonium 15-30g
2) OR Sodium polystyrene sulfonate 15-30g in 50-100mls of 20% sorbitol
Diuretic: Furosemide 1mg per kg IV

5-6.4
If no ECG changes
Use above strategies PLUS
1) 10 units short acting insulin and 25g glucose IV over 15-30mins-max effect at 30-60mins
Consider renal replacement

>6.5 without ECG changes
1) Glucose/Insulin
2) salbutamol 5mg nebulised upto 20mg
3) Sodium bicarbonate 50mmold IV over 5-15mins

5

Hyperkalaemia
ECG changes

1) 10ml 10% calcium chloride IV over 2-5mins
Protects heart
2) Use the above K reducing strategies.
3) Sodium bicarbonate 50mmold IV rapid injection
4) 10 units short acting insulin and 25g glucose IV rapid injection
5) Haemodialysis in resistance to medication

6

Haemodialysis indications

1) Renal failure
2) Oliguric kidney injury
3) Marked tissue breakdown
4) Resistant to medical therapy

7

Hypokalaemia
Caues

<2.5 is severe

GI losses
Drugs
Renal losses
Endo: Cushings, Conns
Metab alkalosis

8

Hypokalaemia
ECG changes and treatment

U waves
T wave flattening
ST segment changes
Arrhythmias (Esp with digoxin)
PEA, VT, VF, Asystole

20mmol per hr max infusion rate
Emergency: 2mmol for 10mins followed by 10mmol over 5-10mins

Correct magnesium commonly low also

9

Must see table on page 117

Must see table on page 117

10

Cardiac arrest post hyperkalaemia

Give 10 ml 10% calcium chloride IV by rapid bolus injection to antagonise the toxic effects of hyperkalaemia at the myocardial cell membrane.
Sodium bicarbonate: 50 mmol IV by rapid injection (if severe acidosis or renal failure).

Glucose/insulin: 10 units short-acting insulin and 25 g glucose IV by rapid injection.

Haemodialysis: consider this for cardiac arrest induced by hyperkalaemia which is resistant to medical treatment. Several dialysis modes have been used safely and effectively in cardiac arrest, but this may only be available in specialist centres that offer acute renal replacement therapy in critically ill patients.