Appendix 1: Hyperkalemia Survey (Part II)
As a member of the Code/Rapid Response Team you have been called to help manage a 7 year old child who is suddenly unresponsive. When you arrive, she is pulseless and CPR has been started. She is in pulseless ventricular tachycardia. You have directed the team to shock, give 2 minutes of CPR and are now preparing for the second shock and asking a pharmacist/nurse to prepare a dose of epinephrine. You confirm that there is a working peripheral IV. You notice the patient is receiving a blood transfusion. You stop the transfusion immediately and stat labs come back revealing a K of 8.3.
Assume when you ask for medications the nurse/pharmacist prepares the proper weight based dose. Please choose from the following list of drugs which drugs/therapies you would request to treat the hyperkalemia, and in which sequence you would administer them (first, second, third, etc.). Also, please check which drugs/therapies you would definitely give, which ones you would only consider for refractory hyperkalemia, and which you would never give to treat hyperkalemia. Please note, we are asking you to identify which drugs/therapies you would consider to treat the hyperkalemia, NOT the arrhythmia. You can make comments as to why a particular drugs/therapies, the route of administration, the sequence or even additional questions you may have, but that is not necessary.
PALS Emergency
Drugs Order of Delivery
Definitely for Severe Hyperkalemia
Maybe for Severe Hyperkalemia
Only for Refractory Hyperkalemia
Not for Hyperkalemia
Comments/
Questions
Adenosine
Albumin
Albuterol
Alprostadil
(PGE1)
Amiodarone
Atropine
Calcium Chloride
Calcium
Gluconate
Dexamethasone
Dextrose
Diphenhydramine
Dobutamine
Dopamine
Epinephrine
Furosemide
Hydrocortisone
Insulin Continuous IV
Infusion
Insulin IV Bolus
Insulin Subcutaneous Bolus Ipratropium
Bromide
Lidocaine
Kalexate® Enteral (Sodium
Polystyrene
Sulfonate)
Kalexate® Rectal (Sodium
Polystyrene Sulfonate)
Magnesium
sulfate
Methylprednisolo ne
Milrinone
Naloxone
Nitroglycerin
Nitroprusside
Norepinephrine
Procainamide
Sodium
Bicarbonate
Terbutaline
Vasopressin
Dialysis:
Hemodialysis Dialysis:
Peritoneal
Dialysis:
Continuous (CAVHD) Hyperventilation
Other:
Other: