Hyperkalemia AND Sine Waves

Nurseboy1 · Oct 2, 2008

How about pushing calcium, insulin and D50. The resulting decrease in potassium should change how the rhythm looks.

Editorial Team / Admin · Oct 2, 2008

If patient is pulseless/apneic and appears wide-complex dysrhythmia (V-tach), yes, defibrillation is warranted along with tx cause (hyperkalemia) as Nurseboy1 stated: CaCl, D50, insulin. But, if looks like PEA, CPR and tx cause (hyperkalemia).

poppy07 · Oct 3, 2008

so, consider this:

pt was coded multiple times through the day, revived, and then made a DNR-so at this point, calcium chloride was given, but no shocking.

By the way, this patient had continuous drips of D20W and insulin 10 units/hr, as well as rounds and rounds of bicarb, and calcium gluconate, calcium chloride. Pt also had a line placed for CRRT, started the CRRT with NO removal rate and very slow blood flow rate, which precipitated the decrease in HR and then to wide qrs/ sine waves. THERE WERE NO CHANGES in the rhythm form after administering the CaCl; at this point the patient was DNR and the meds didn't do the job

Putu2Sleep · Oct 3, 2008

what exactly was the patients K throughout the day

poppy07 · Oct 4, 2008

6+ to 7 or so

Putu2Sleep · Oct 4, 2008

i find it hard to believe even by starting crrt and giving all the insulin and Ca it didn't change. did you try kaxalate?

seanpdent, ADN, BSN, MSN, APRN, NP · Oct 4, 2008

I always hated those situations with massive interventions, torturing the patient.

And in the end... a DNR or no defib was ordered.

I understand the situations vary and each patient scenario is unique. Just always frustrating and sad.

poppy07 · Oct 7, 2008

The change from sine waves to idioventricular to asystole. how about that! pt had a GI bleed so kayexalate was not among options that the docs were ordering. crrt only ran about 5 minutes or less, and then pt brady'd down. the sine waves were a very late development before the patient coded the last time on their way out.