Insulin during cardiac arrest?

TopherSRN · Mar 31, 2008

"Calcium (chloride) is indicated for hyperkalemia during a code. And, it is indicated first line for severe hyperkalemia."

Why do you keep repeating this? Its cookbook medicine and not even the point I was making. You were incorrect in saying that Ca corrects hyperkalemia, when it in fact does NOT. Its a bandaid fix that treats the symptoms, and not the problem. Im well aware of its indications.

Gluconate can be used, its largely MD preference (one of our surgeons preferred it in a non-emergent situation), but CaCl has roughly 3x the elemental Ca.

Editorial Team / Admin · Mar 31, 2008

Gluconate can be used, but CaCl has roughly 3x the elemental Ca.

Yes, I, too am very well aware of this (thus my placing 'choride' in brackets above to indicate only one).

allnurses Guide · Apr 1, 2008

Wow "topherSRN", you're very aggressive. Chill out.

nursejill155 · Apr 1, 2008

I agree, calm down topher, we get it.

shadow92182 · Apr 28, 2008

Hyperglycemia can be a cause of PEA and therefor would require the use of IV insulin during the code?

Chayo1989 · Apr 29, 2008

I've only given insulin during cardiac arrest once. The patient was known to be hyperkalemic, and i an effort to decrease the potassium the patient was given an amp of D50% and 10 units of regular insulin iv. This was implemented in addition to ACLS protocol.

sicushells, RN · Aug 12, 2008

ACLS protocol keeps being brought up, often with the statement "I've given IV Insulin in addition to/outside of/despite/etc. the protocol, However:

ACLS protocol states that possible contributing factors should be treated, including hyperkalemia. So wouldn't IV insulin for known/suspect hyperkalemia be indictated per protocol? I know I'm arguing technicalities here, but I did want to point out that even though it's not one of the boxes, IV Insulin is still indicated within the protocol.

nursejill155 · Aug 12, 2008

I agree with you....ACLS is a protocol that we all follow but I think if my pt has a K of 8.8 I probably would push some insulin to see if it helps. It is probably not the only contributing factor to the code but it may help, why not give it a shot! I think ACLS should be followed but we must look at the pt individually also!

kvsherry · Aug 13, 2008

I have seen it done as a last ditch effort, usually a few minutes in. Not as a first line drug though. And yes, I was told that it is to try to push the K back into the cells. Like I said, usually a last ditch effort.

tridil2000, MSN, RN · Aug 16, 2008

The concept of insulin working to shift the k back into the cells only holds up if the circulation is intact to circulate it out of the right atrium, to the lungs and then over and out of the left ventricle. It just wouldn't circulate enough systemically to work. Additionally, glucose travels with it into the cells and then you bottom out pt's sugar. So insulin iv for hyperkalemia always needs to be followed by an amp of d50. Also worth noting, you never correct hyperkalemia in an acidotic state, like dka...or a code. If the acid is corrected - k will shift on its own back into the cells. Therefore, you'll end up severe hypokalemia if you correct the ph AND the kyperkalemia in acidotic pts.

Calcium is a better choice if you suspect hyperkalemia. It will protect the cardiac cells from the irritability and subsequent arrythmias.

juraviel · Aug 16, 2008

As stated in previous posts insulin and dextrose do not start working for 20-30 min. So if you are trying to correct hyperkalemia your drugs of choice will be calcium or bicarb. The onset of action for both of these drugs is less then 5 min.

stiltarget · Aug 27, 2008

you can tell that researcher that O2, and getting the O2 into the coronaries and brain is paramount, and cellular death occurs after 4 minutes without it.

hoooorar!!!!!!