p3medic Posted September 17, 2009 Share Posted September 17, 2009 What Chbare said. Sux will increase serum potassium, and given the EKG and history it is most likely hyperkalemia that killed this pt. Calcium Chloride, NaHCO3 and albuterol would be helpful, perhaps insulin/glucose for those who carry it. Link to comment Share on other sites More sharing options...
mobey Posted September 17, 2009 Share Posted September 17, 2009 I agree ch, Rocuronium would have been a better choice. Link to comment Share on other sites More sharing options...
ERDoc Posted September 17, 2009 Share Posted September 17, 2009 I'm a little late to the game, but I've got to agree with chbare, p3 and mobey. It was the sux that killed this one. The 12 lead is almost classic for hyperkalemia. Add to that the increase K from the sux and you are looking to kill your pt. Though not ideal, if there was no other paralytics available just sedate and intubate. Link to comment Share on other sites More sharing options...
jimbreedon Posted October 7, 2009 Share Posted October 7, 2009 I'd would say 2 things killed this patient. (1) Non-Adherence and (2) hyperkalemia. The 2nd being a direct result of the 1st. K+ elevation caused a fatal arrhythmia. Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted October 7, 2009 Share Posted October 7, 2009 I'd would say 2 things killed this patient. (1) Non-Adherence and (2) hyperkalemia. The 2nd being a direct result of the 1st. K+ elevation caused a fatal arrhythmia. Actually what killed this patient was not the paramedic or the sux. They were the bringers of death but this patients disregard of dialysis and then going shopping is what killed him. Had he have not missed dialysis for 5 days he might have survived. He had enough time to go shopping then he had enough time to make it to his dialysis appointment. Link to comment Share on other sites More sharing options...
Mateo_1387 Posted October 7, 2009 Share Posted October 7, 2009 Actually what killed this patient was not the paramedic or the sux. They were the bringers of death but this patients disregard of dialysis and then going shopping is what killed him. Had he have not missed dialysis for 5 days he might have survived. He had enough time to go shopping then he had enough time to make it to his dialysis appointment. The patient did not die until EMS started improperly treating the patient. Link to comment Share on other sites More sharing options...
HERBIE1 Posted October 7, 2009 Share Posted October 7, 2009 Agree with everyone here about what happened, except that I have a question. Why were they attempting to intubate the patient with O2 sats at 89%- what's the big hurry? Granted, we are limited by not having a chemistry profile, but it doesn't take a rocket scientist to surmise what was going on with this patient. High flow O2, diuretics, NTG, CPAP, CaCl2, Bicarb- all options depending on your system, and what you know. Unless this patient arrested, I see no reason to rush to intubate (even then, it's not priority one), since if you address the underlying issues, the breathing will improve. Assist ventilations PRN, but even without knowing the interaction between sux and K(we do not use it), intubation should not have been job one. I'm all for being aggressive in patient care when appropriate- especially those with signs of heart failure, but I think the crew's priortities were screwed up here. If they knew the patient had not been dialysized in 5 days, it should have easily explained the EKG as well as the patient's signs and symptoms. Too often we get focused on playing with our toys, using our technical skills, and forget the KISS principle(keep it simple, stupid). Link to comment Share on other sites More sharing options...
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