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急診護理個案討論

急診護理個案討論. 新光醫院 急診科 張志華 醫師. 2005 / 09 / 15. Hyperkalemia. 常考！. Hyperkalemia. Symptoms Generalized fatigue Weakness Paresthesias Paralysis Palpitations. Nonspecific ！. Hyperkalemia. 考題！. Etiology Acute or chronic renal failure Crush injuries (rhabdomyolysis), burns

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急診護理個案討論

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  1. 急診護理個案討論 新光醫院 急診科 張志華醫師 2005 / 09 / 15

  2. Hyperkalemia 常考！

  3. Hyperkalemia • Symptoms • Generalized fatigue • Weakness • Paresthesias • Paralysis • Palpitations Nonspecific！

  4. Hyperkalemia 考題！ • Etiology • Acute or chronic renal failure • Crush injuries (rhabdomyolysis), burns • Foods (eg, bananas, oranges, high-protein diets, tomatoes, salt substitutes) • Redistribution: Acidosis, insulin deficiency, beta-blocker, acute digoxin overdose, succinylcholine, periodic paralysis (PP) • Drugs – slow-K, spirinolactone diuretics, NSAIDs

  5. Hyperkalemia • Mild: 5.5-6.5 mEq/L • peaked T waves • Moderate: 6.5-7.5 mEq/L • prolonged PR interval • decreased P wave • ST depression or elevation • slight widening of the QRS

  6. Hyperkalemia (cont.) • Severe: 7.5-8.5 mEq/L • wide QRS • flat and wide P waves • VPCs • Life-threatening: >8.5 mEq/L • loss of P • AV blocks • VT / VF • sinusoid patern

  7. Hyperkalemia • Specific management: "See BIG Potassium Drop" • Calcium • Bicarbonate • Insulin and Glucose • Kayexalate • Dialysis 考題！

  8. Hyperkalemia • General management: • Continuous ECG monitoring • DC K-sparing drugs (ACEI, spirinolactone) • DC high-K foods

  9. Calcium • Stabilize cell membrane • Calcium gluconate 10%, 10 ml over 2-5 min • 2nd dose after 5 min if no response • Effect occurs in minutes and lasts for 1 hour • Further calcium ineffective unless hypocalcemia exists • Digoxin Toxicity  contraindication !

  10. Bicarbonate • Shift K+ to intracellular • 3 amp Jusomine IV over 5 min • May repeat q10-15 min • Onset in 30 min; duration: 1-2 hours • Avoid bicarbonate if: • Hypocalcemia • Severe lung edema

  11. Glucose and Insulin • Redistribution • RI 10U + D50GW 50cc over 5 min • Consider Albuterol Neb as adjunct • Onset 50-60 min; duration: several hours • Follow F/S

  12. Potassium Removal • Cation-Exchange resin (Kayexalate) • 15-30 gm PO q3-4 hrs or 50 gm in 200 ml retention enema for 30-60 min q4hr • Dialysis: May experience significant hyperkalemia on rebound

  13. Summary • Hyperkalemia • Symptoms? • Diagnosis? • EKG? • Etiology? • Treatment?

  14. 南丁格爾誓言 余謹以至誠 於上帝及會眾面前宣， 終身純潔，忠貞職守 盡力提高護理專業標準， 勿為有損之事， 勿取服或故用有害之藥， 慎守病人及家務之秘密， 竭誠協助醫師之診治， 務謀病者之福利。 謹 誓

  15. 德蕾莎修女 一顆純潔的心會 自由的給予 自由地愛 直到它受到創傷....

  16. 謝謝聆聽

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