Identifying and managing hyperkalaemia in the prehospital environment

Hyperkalaemia is defined as a high level of potassium within the blood. Potassium concentration is normally tightly regulated at 3.5–5.5 mmol/litre. Hyperkalaemia can have major consequences for muscle, nerve and cardiac function, leading to arrhythmias and cardiac arrest. It has many causes, including disease states, trauma and medication; a tourniquet can lead to pseudohyperkalaemia. Some patients are at a greater risk of developing it. Hyperkalaemia is most accurately identified through blood tests but results of these may not be available prehospitally. Paramedics need to take a thorough history and carry out an electrocardiogram (ECG) to diagnose hyperkalaemia. ECG results can indicate the severity of the condition, and a guide to the ECG changes corresponding to serum potassium levels could help paramedics in diagnosis. Nebulised salbutamol is recommended as the first-line management of hyperkalaemia in several healthcare areas but there are no protocols that enable UK paramedics to provide this, even though emergency vehicles carry the drug and paramedics administer it for other conditions. Establishing such protocols would allow paramedics to treat patients effectively at the scene and en route to hospital.

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