Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


Hyperkalemia, Marine Envenomations, and SBO

  • In addition to the 1st line treatments of calcium, insulin-d10, bicarbonate and dialysis, effective treatment of hyperkalemia involves β2-agonists; 20mg albuterol nebulized over 10 minutes or terbutaline 0.5mg IV quickly drives potassium intracellularly.
  • Proper treatment of most marine envenomations, catfish being the most common, is hot water soaks for 30-90 minutes with good wound care and a quinolone or augmentin for 5 days.
  • CT abd/pelvis is only 92% sensitive for small bowel obstruction.  Keep an open mind if you have strong clinical suspicion.
    • Allon M. Hyperkalemia in end-stage renal disease: mechanisms and management. J Am Soc Nephrol. 1995;6(4):1134.
    • Allon M, Copkney C. Albuterol and insulin for treatment of hyperkalemia in hemodialysis patients. Kidney Int. 1990;38(5):869.
    • Carrette TJ, Cullen M, et al. 2002. Temperature effects on box jellyfish venom, a possible treatment for envenomated patients? Med J Aust. 177: 654.
    • Glenister KM, Corke CF. Infarcted intestine: a diagnostic void. Journal of Surgery 2004. 74:260
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  1. Just FYI: Nancy Gritter said that insulin/dextrose was the quickest way to correct hyperkalemia in her previous lecture.

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