I have been a critical care nurse for less than a year, so I am looking for advice from nurses who have more experience with this situation.
I admitted a patient with a potassium of 6.4, BP 200/100, EKG with peaked T waves and occasional PVCs, and c/o weakness. Despite spending over 5 hours in ER, the only treatment she had received was an amp of D50 and 10 units of insulin. It was a Sunday afternoon and I work in a small hospital. Our pharmacy had left for the day, which meant the house supervisor was responsible for any medication problems. I had both calcium gluconate and sodium bicarb ordered, but due to issues with our pyxis and hospital policies, I was unable to give either without help from the supervisor. I repeatedly asked the supervisor for help, but he was so overwhelmed with various emergencies that I didn't receive either medication by the end of my shift. By the time the night supervisor came on and addressed the medications, 2 1/2 hours had elapsed since the patient was admitted to the floor.
My question is - during this time of waiting I was VERY upset. In my experience, patients with a critical high potassium and EKG changes should be treated as a ticking time bomb. At the end of my shift I ended up calling my director. Was I overreacting? Is the risk of sudden cardiac arrest or wide complex tachycardia not as high as I imagine?
Were they having widened QRS complexes? Calcium is more for stabilizing the myocardium when they've progressed to the point that they're having widened QRS complexes.
Were they acidotic? Bicarb is more for correction of acidosis because acidosis contributes to hyperkalemia. Correcting the acidosis causes K+ to shift back into cells.
In any case these are bandaid solutions (including insulin/dextrose). Ultimately the potassium needs to be excreted or dialyzed out. Peaked T waves are a pretty early sign along the continuum of hyperkalemia so they might not have felt the need to be overly aggressive.
mcubed45
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Were they having widened QRS complexes? Calcium is more for stabilizing the myocardium when they've progressed to the point that they're having widened QRS complexes.
Were they acidotic? Bicarb is more for correction of acidosis because acidosis contributes to hyperkalemia. Correcting the acidosis causes K+ to shift back into cells.
In any case these are bandaid solutions (including insulin/dextrose). Ultimately the potassium needs to be excreted or dialyzed out. Peaked T waves are a pretty early sign along the continuum of hyperkalemia so they might not have felt the need to be overly aggressive.