Matthew Metcalf
Journal of Paramedic Practice, Vol. 9, Iss. 6, 02 Jun 2017, pp 264 - 269

Hyperkalaemia is a potentially life-threatening metabolic emergency and is the
most common electrolyte disorder associated with death. The author attended
an incident where a patient suffered asystolic cardiac arrest from hyperkalaemia
and was subsequently resuscitated successfully to hospital discharge with good
neurological outcome. This piece intends to review all relevant available literature
with the aim of developing recommendations to aid paramedics in managing
cardiac arrest secondary to Hyperkalaemia. Despite the lack of current goodquality
evidence for pharmacological interventions, systematic reviews available
have led to the development of clear guidelines. The use of calcium chloride
and sodium bicarbonate is recommended, and these are both carried by Critical
Care Paramedics (CCPs). Salbutamol therapy has the strongest evidence base of
any intervention available out of hospital. It should be considered after the use
of the aforementioned medications if the patient achieves ROSC. Consideration
must also be taken as to whether the patient would benefit from being moved to
hospital to reach vital interventions such as insulin/dextrose therapy and dialysis.

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