Calcium Chloride in Pediatrics

[spenac]

There is so much more to EMS than load and go. Take time and do a proper exam it does not actually delay transport plus your exam could lead to activating proper staff so your few second extra on scene actually saved your patient perhaps hours in the ER.

[mobey]

and depressed DTR's on patients who are receiving mag sulfate.

Take care,

chbare.

Hey buddy, can you fill me in on this abbreviation?

[Ridryder 911]

DTR = deep tendon reflexes. These should be checked q 5 -15 minutes when anyone is receiving Mg+

[Arizonaffcep]

how are you going to even know other than seeing peaked t-waves on ECG or w/o a lab sp read sheet produced by dialysis center or NH?

A not uncommon scenario for this pre-hospital would be the dialysis Pt who is in an arrest situation, with an unk last dialysis time-line. IF you carry it, can also use D50/insulin combo, plus Albuterol neb (in-line with BVM).

[akroeze]

Would you actually nebulise the salbutamol? I would probably be more inclined to just squirt it down the tube. After all, we're not trying to get it to all the alveoli like in bronchoconstriction, we're trying to get rapid distribution into the blood stream.

Unfortunately for me the only two options I have are bicarb (we only carry one amp) and salbutamol.

[Ridryder 911]

A not uncommon scenario for this pre-hospital would be the dialysis Pt who is in an arrest situation, with an unk last dialysis time-line. IF you carry it, can also use D50/insulin combo, plus Albuterol neb (in-line with BVM).

Might as well give Kayexalate then. Personally, I would not give the Insulin/D50 combo until I had a good base line labs. At least the Albuterol and Kayexalate has lesser side effects. and is easier to contol.

R/r 911

[chbare]

Kayexalate would not be my primary choice in a suspected hyperkalemic arrest situation as described above. It's action is much longer than calcium chloride, albuterol, or dextrose/insulin. I would go with stop gap measures to hide the potassium and stabilize the membrane potential first.

Obviously, kayexalate will be very important in the elimination of potassium in the long term.

Take care,

chbare.

[spenac]

This discussion is over my head. I am going to have to do some research on these drugs and combinations brought up by you guys. The short term and long term affects, etc, holy crap I know way to little. Here is some quick research I have found. Now I NEED TO DIGEST THAT AND SEE WHAT QUESTIONS i COME UP WITH.

http://www.drugs.com/mtm/kayexalate.html

http://allnurses.com/emergency-nursing/the-order-278238.html

http://www.templejc.edu/dept/ems/drugs/insulin.html

http://www.sopharma.com/salbutamol.phtml

[AnthonyM83]

Just as additional info for your research:

My drug guide states dosages as:

Adult:

2-4mg/kg as prophylaxis prior to calcium channel blocker admin

8-16mg/kg for hyperkalemia and calcium channel OD

Pediatric:

5-20mg/kg

all can repeat in 10 min as needed. So, while Ped dose doesn't differentiate which indication you're giving it for, max dose is higher, regardless.

My county's specific protocol, though lists:

Adult dose: 1,000mg

Ped dose: 20mg/kg (max 500mg - single dose)

Is it once specific drug book that made a mistake or gave a different dose a specific reason, but didn't explain it and then spread from there?