structure
Forum Junior
Topics: 26
Posts: 28
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One day after missing her dialysis treatment, a 27 yr old woman comes to the physician because because of generalixed weakness. Her blood pressure 95/72 mmHg, and pulse is 45/ min and regular. Examination shows a well-functioning arteriovenous fistula in the left upper estremity. Muscle strenghth is 3/5 in all extremities. An ECG shows third-degree atrioventricular block. Laboratory studies are ordered. which of the following is the most approproate next step in management?
A. Kayexalate-sorbitol enema
B. Intravenous administration of calcium gltconate
C. Oral adminstriation of soduim polystyene sulfonate(Kayexalate)
D. Immediate placement of a pacemaker
E. no treatment pending laboratory results
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| Perhaps
Forum Elite
Topics: 61
Posts: 162
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I am not sure.
I picked D pacemaker.
But if the cause is hyperkalemia, maybe B calcium gluconate?
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| frank100
Forum Guru
Topics: 48
Posts: 586
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(d), naturally, third degree heart block is an indication for pacing...
by having this rhythm, you already know you are in troubles, so pace him and them take care of electrolites. If you donīt do so, you will end up having a "ACLS knowledge show in the ER, and you donīt want that."
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| HighHopes
Forum Senior
Topics: 12
Posts: 165
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Frank, I agree with you if they ask about longterm treatment of third degree block but in this situation shouldn't we strat fixing the problem (ie give ca and Kayexalate)?
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| shumaila
Forum Elite
Topics: 58
Posts: 347
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D???
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| juanma0
Forum Senior
Topics: 10
Posts: 146
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no way, 3rd degree heart block could go into V/fib or death, treat that first!! She probably has only mild hyperkalemia if any because she only missed 1 dialysis. Calcium gluconate is cardioprotective but does not treat hyperkalemia per se, what would u have left to protect, dead myocardium?
Didnt mean to be rude but it just seems clear to me.
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| frank100
Forum Guru
Topics: 48
Posts: 586
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highhopes, I clearly understand you, but maybe the one did the question wanted us to learn to differetiate between emergency and non-emergency situations.
You try to lower K+ to protect the myocadium, right. but there is no hypokalemic drug in this world that will normalize K+ levels fast enough so you can address both situations at the same time. in that instance a 3rd degree HB, is a almost deadly rhythm, and you can take care of it STAT. thatīs why you pace first.
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| frank100
Forum Guru
Topics: 48
Posts: 586
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look for ACLS new guidelines, cool stuff. I adore it...!!!
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| cbenitesch
Forum Senior
Topics: 10
Posts: 141
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Iīll go B) CRF with no dialysis will lead you to high K! so probably is the case of this patient, K overdose can stop the heart, AV block she has slow cardiac rythm musce weaknes, I think is B)... by the way! a short one!.... If you have a K overdose the heart will stop on systole or dyastole?...
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| loser
Forum Guru
Topics: 34
Posts: 341
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has to be d
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