Kiddo

[chbare]

You guys are very close to the answer. Take these three concepts and see if you can make something fit.

1) Some sort of neuromuscular disorder perhaps a dystrophy?

2) May be related to the RSI medications?

3) May involve an electrolyte?

Take care,

chbare.

[Kaisu]

Ok - so sucs - depolarizing neuromuscular blocker drives potassium out of the cells.. blood potasium levels rise like crazy.. result - hyperkalemia and histamine release - already a problem.

AND tada.. sucs is contraindicated in neuromuscular disease.. which you have to uncover during the history.. DING DING DING.. now I feel so dumb

PS.. thank you for the great scenario chbare. I won't forget this possibly lethal side effect of sucs. I feel like I should pay you tuition or something. :wink:

[Kaisu]

PS - I went back to the rhythm strip and sure enough, there was that peaked T wave on the first brady beat.... and the wide sine wave looking complexes for the next two...

now I feel even dumber

[chbare]

Looks like you guys nailed it! What kind of dystrophy do you think this little guy has? Hyperkalemic arrest has been documented in little guys with an undiagnosed form of this dystrophy. You go to RSI, push the sux, and suddenly you are running an arrest. Hint: sex plays a role.

So, now that we know what is going on, how will we treat this arrest?

I am glad you enjoyed this scenario and hope you all had fun with it.

Take care,

chbare.

[chbare]

PS - I went back to the rhythm strip and sure enough, there was that peaked T wave on the first brady beat.... and the wide sine wave looking complexes for the next two...

now I feel even dumber

Do not feel dumb, I set you guys up with the whole respiratory scenario as a major distracter. More than anything, I wanted people to think about all potential causes of arrest and see how conditions and medications can play a complex role in an arrest scenario.

Take care,

chbare.

[Kaisu]

Thank you google

Duchenne muscular dystrophy (DMD) is a severe recessive x-linked form of muscular dystrophy that is characterized by rapid progession of muscle degeneration, eventually leading to loss in ambulation, paralysis, and death. This affliction affects one in 3500 males, making it the most prevalent of muscular dystrophies. In general, males are only afflicted, though females can be carriers. The disorder is caused by a mutation in the gene DMD, located in humans on the X chromosome. The DMD gene codes for the protein dystrophin, an important structural component within muscle tissue. Dystrophin provides structural stability to the dystroglycan complex (DGC), located on the cell membrane.

Treatment

# Intravenous administration of glucose and insulin, which promotes movement of potassium from the extracellular space back into the cells.

# Intravenous calcium to temporarily protect the heart and muscles from the effects of hyperkalemia.

# Sodium bicarbonate administration to counteract acidosis and to promote movement of potassium from the extracellular space back into the cells.

# Diuretic administration to decrease the total potassium stores through increasing potassium excretion in the urine. It is important to note that most diuretics increase kidney excretion of potassium. Only the potassium-sparing diuretics mentioned above decrease kidney excretion of potassium.

# Medications that stimulate beta-2 adrenergic receptors, such as albuterol and epinephrine, have also been used to drive potassium back into cells.

# Medications known as cation-exchange resins, which bind potassium and lead to its excretion via the gastrointestinal tract.

# Dialysis, particularly if other measures have failed

[CBEMT]

Seconds after placing the ETT tube one of the nurses states, "what the hell?" You turn to the monitor and note the following.

Turn to MD and say, "This is why you should've called the transport team at Children's in the first goddamn place. Which, by the way, you're going to do as soon as we get a @#$%ing pulse back."

[WelshMedic]

Thanks too, chbare, from me. You have given a lot to think about in this scenario, especially me.

Although I was only able to contribute in the initial stage of this scenario, I have enjoyed the subsequent entries. A real puzzle. I knew where we were going at the point where mom stated that he was having trouble getting around. DMD is a genetic disorder that is, bizarrely enough, more prevalent in the area of Wales where I grew up.

My next door neighbour and best friend had it too. He saw him go from being my football buddy to wheelchair bound and spoon fed. Then one summer he went into hospital and never came home again. I cried for what now seems like a year. I still miss him now as I type this behind the PC. He would have loved the internet, he was always into gadgets and stuff.

Sorry for the melancholy, and thank you for indulging me.

WM

[firedoc5]

This reminds me of why I hated peds. Too unpredictable. KEWL case though.

[chbare]

Thanks too, chbare, from me. You have given a lot to think about in this scenario, especially me.

Although I was only able to contribute in the initial stage of this scenario, I have enjoyed the subsequent entries. A real puzzle. I knew where we were going at the point where mom stated that he was having trouble getting around. DMD is a genetic disorder that is, bizarrely enough, more prevalent in the area of Wales where I grew up.

My next door neighbour and best friend had it too. He saw him go from being my football buddy to wheelchair bound and spoon fed. Then one summer he went into hospital and never came home again. I cried for what now seems like a year. I still miss him now as I type this behind the PC. He would have loved the internet, he was always into gadgets and stuff.

Sorry for the melancholy, and thank you for indulging me.

WM

Sorry to hear that, it is a horrible disease without any know cure.

I am glad everybody had fun with this scenario. Anytime hyperkalemia is a concern we need to be very careful about using Sux. Other conditions we need to consider: Renal failure with hyperkalemia, acidosis with hyperkalemia, spinal cord injury, crush injuries, and burns to name a few. In addition, a history of malignant hyperthermia should be a contraindication. Many other considerations exist as well.

Take care,

chbare.