Hyperkalemia – Potassium can be increased by prescription meds.

The importance of prescription medications cannot be over emphasized when considering medication administration in an emergency.  In a recent conversation with Mark Albert I discussed this topic and some of the problems we see in the field.  Mark is going to post here on occasion and welcomes your replied in the “comment” section of his post. Welcome Mark!

Hyperkalemia caused by prescription medications

Its is imperative that an astute medic obtains a comprehensive medical history from family and caregivers in the setting of a Cardiac Arrest. This can assist you in the performance of running the “H and T’s,” from a pharmacological perspective.

Some root cause can be electrolyte driven, iatrogenic (overdose), drug interactions, or medications that prolong QT interval.

For the purpose of this blog, I will only discuss, one electrolyte driven that will manifest as Hyperkalemia.

One major category and widely used medical classes are the Angiotensin Converting Enzyme Inhibitors (ACE) or Angiotensin Receptor Blockers (ARB) medications, that are implicated in Hyperkalemia These medications are clinical indicated for Hypertension, Heart Failure and to renal protection (frequently in Diabetic patients).

Such examples are: Captopril, Enalpril, Lisnopirl, Qunapril, (ACE)

Diovan, Micardis, Cozaar, Atacand, Benicar (ARB)

In essence, they suppress Aldosterone and cause endogenous Potassium to increase. Aldosterone is responsible for renal clearance of potassium, thus allowing more potassium to accumulate in the body.

Therefore, you may see High T waves and wide QRS intervals. It may be prudent in PEA situations, to articulate to your Medical Control (based on your local protocols) to suggest the usage of Calcium Chloride or Gluconate, as a membrane stabilization agent. Dextrose, Albuterol and Insulin also help lower potassium levels.

For more information on Potassium and medications that affect potassium click here.

Author:

Mark L Albert Rph, PharmD Candidate is a Pharmacist, EMS Consultant, Pharmacy Consultant for NYC REMSCO, and Independent Pharmacy-EMS Blogger.

Pre-hospital Care – Don’t forget the most important part.

In the course of your EMS education we teach you how to check for pulses and begin CPR, we teach you ACLS, PALS, GEMS  and all other forms of invasive life saving treatments.  In retrospect there is a large percentage of patient care that is more CARING than life support.

When watching disaster scenes from Japan and the recent Tornadoes in North Carolina i was again reminded of the deeply personal side of disasters and emergencies.  In the footage of these disasters you see people helping people, people lending a hug or a hand to a neighbor.

In the delivery of patient care we need to be excellent at life saving skills but we also need to be excellent in the way we care for our patients, their families and the public.

I used to work with a medic named George who was older than I.  George taught me the most valuable lesson in EMS.  I was a young buck who wanted to defibrillate ventricular fibrillation and intubate people and start large bore IV’s.  George had a different view.  “George, what are we doing here.  This is a BLS  job.”   George would say, “Those life saving jobs are far and few between.  Our ob is to take care of people.”  I would watch care for people he knew in his neighborhood by greeting them, listening to his patients and relating to the community.  Gradually I learned that there are more opportunities to help people than defibrillate them.

I learned that by holding the door for an elderly woman entering a building or helping a child with HIV smile we deliver a far greater medicine than breytilium or lidocaine.  I know what you are thinking, “Steve, we no longer give those medications.”  I know, but caring never goes out of protocol.

Think about why you like doing patient care and how you can re-arrange your goals so you have more rewarding moments in EMS than stressful ones.

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Speaking of Pediatric Life Support – Kids Can Really Compensate! Tome, Japan

I was looking through the CNN RSS feed of the radiation problems in Tokyo  (yes, that is what paramedic instructors due on their day off!)  I am also reviewing PEDS for upcoming lectures and I found it remarkable that the kids in Japan are playing to deal with the stress and aftermath.  I guess kids can p whether in hypovolemic shock or in a disaster.

Play video of children in Tome, Japan.

Really, kids will be kids.  Kids are playing because that is what kids do.  I recently read an article that said kids will follow their mother’s reaction to disaster.  If the mom is upbeat, the kids will be upbeat.

I remember the expression from the 70′s, “Keep on trucking.”  Whether the story is the Japan Earthquake, the North Carolina Tornado’s, the World Trade Center, the goal is to be resilient and be prepared.  It is not what separates people that make sus great, it is what bring us together.

Disasters and emergencies make best friends out of distant neighbors.  I call it Boyle’s Law of disaster management.

Stay safe, stay prepared! Go play in the yard!  (BTW this child is wearing a N95 Mask.)

North Carolina Tornados

On April 16, 2011 I was driving south on Route 95 with my family heading to Florida.  We always stop at Fullers BBQ in Lumberton North Carolina on the way south. We encountered heavy rains about 30 miles north of Lumberton.  The kids were safely nestled with seat belts on watching a movie on DVD.    We had seen people who stopped their cars under overpasses and figured the rain was too heavy for them to drive.  I was certain of my vehicle and new tires being able to handle the weather.We continued driving south until the traffic stopped.  As we waited we tried to find a news channel to find out what lied ahead.  Many of the stations were out of reach or playing music. Traffic clearly was not moving at all and people started turning their cars off and opening their car windows.

“Did you hear what is going on?” I asked the next car.

“Tornadoes in the area.  Listen to FM 103.6.”  Thank you I replied.

I have noticed for some time how in our daily routine we go about our lives near people but relatively isolated.  When times are bad the pressures of the incident change our attention to each other.  A stranger in a car next to you when speeding down the highway is now a source of help in an accident or an emergency.  Kind of Like Boyle’s Law of disasters. (Thanks NASA)

I heard on the news that a local Loews Home Improvement center had been devastated.  I tried to navigate my way to the site but traffic was stopped at every intersection around the  devastated area.  I was impressed at the adaptability and helpfulness of Lee county Sheriffs and Fire Department personnel.

I have posted some links for you:

Loews Home Center devastated, customers saved by emergency plans:

http://www.npr.org/templates/story/story.php?storyId=135498048

Emergency Service Radio and News Coverage of emerging tornadoes

http://statter911.com/2011/04/16/possible-tornadoes-moving-through-north-carolina-watch-listen-live/.

The tornado that injured her was an EF-1 – packing winds up to 88 mph – that touched down about 3 miles east of Parkton just after 5 p.m., according to the NWS. It first touched down along Parkton-Tobemory Road, halfway between U.S. Highway 301 and Interstate 95., then tracked north-northeast.

An EF-1 tornado touched down about 6 miles southeast of Lumberton between 4:30 and 4:45 p.m. The tornado then skipped along a track to the north-northeast, creating sporadic damage, according to the NWS.

Witnesses said that two funnel clouds merged when the tornado touched down near Pope Crossing Road, damaging a shed and mobile home. At the site of another touchdown, two sheds and about a dozen trees were knocked down just south of Beulah Church and Old Whiteville roads. The tornado lifted before crossing Old Whiteville Road and moving into a swampy area, the NWS reported.

Interstate 95 was closed for about an hour in Cumberland County due to accidents and downed trees. Extensive delays developed during mile markers 40 and 44. State troopers said that after the initial accident, other drivers wrecked while trying get around the scene. One wreck involved an overturned tractor-trailer.

Joe Mosso said he saw a tornado heading north on I-95 while entering at the Highway 24 interchange.

“It looked to be about 2 miles wide, and it was just as black as black could be,” Mosso said.

Brad Losh witnessed a funnel cloud while driving on I-95.

“I jumped out of my car and looked at it,” Losh said. The funnel cloud then went over the top of his head, he said. Obtained from  http://www.wral.com/weather/story/4824789/ on April 17, 2011)

Upcoming Webinar MCI Management for the Real World

On April 28, 2011 at 7:00 est I will be giving a presentation on the Management of mass casualty incidents (MCI)in the real world. Through a career of working as a medic, supervisor and educator I have honed a system that makes transitioning form one to many patients in a logical manner.

Register here: http://emsseo.com/2011/04/webinar-4-ts-method-of-mci-management/” target=”_blank”>http://emsseo.com/2011/04/webinar-4-ts-method-of-mci-management/

When we are dispatched to a MCI EMS providers hesitate because we find MCIs to be different and we are no longer in charge. During this Webinar I will show you how to bridge the transition from caring for one to many patients.

Webinar topics:

Span-of-control
Accountability
Scene safety strategies
Safety rules to live and stay alive by

Register here: http://emsseo.com/2011/04/webinar-4-ts-method-of-mci-management/” target=”_blank”>http://emsseo.com/2011/04/webinar-4-ts-method-of-mci-management/