I just got home from 7 days in the ICU yesterday and came close to cardiac arrest twice. They call it "rapid response team" when you are about to code. My problem was pneumonia caused by the flu and caused my arterial oxygen to drop into the 60’s which is very bad. I had great team of doctors who pulled me through the illness.
This happened to me a little over 20 years ago. I had been through a massive trauma that broke many bones and caused extensive internal damage. Two weeks after I was put under for another procedure (using succ) and went into cardiac arrest. For over 30 minutes attempts were made for resuscitation which included cracking my chest and hand massaging / shocking my heart. What surprised many medical people and myself was that I had no heart or brain damage. The Chief of Anesthesiology visited me and explained in a manner similar to this vid. Thanks for the video.
Man… we need more doctors like you. You saved this man’s life. So taking to much albuterol can cause this or would it actually reduce your potassium? When I had Covid I was taking albuterol like crazy. I’m talking every 4 hours like clockwork because I just couldn’t breathe. My potassium came back slightly lower than normal but doctor wasn’t concerned.
@@ZzTop-vj5wo yikes!! I’m sorry to hear that. How are you doing now? I honestly think I was headed in that direction. I was taking trelegy and duoneb like an idiot and my pulmonologist said that was like double treatment and I should stop immediately switch to albuterol but the shortness of breath was so bad I just wanted relief. I haven’t been 100 percent since that day.
no doctor in Sweden thinks this way, they do not do anything quickly and a dead patient is one less worry and hardwork to handle... every doctor I met here is gaslighting you from start to finish and you get just more and more sick,... is amazing doctors like this one even exist.. I can hardly walk up without pressue on my heart, getting all sweaty and feel like there is a stone in my heart and cramp in my left arm all the time , and shoulder and heart rate go up to 150-180 from just simple walking in stairs or out in the park.... feels like passing out with a wrench around the heart and hard to breath as soon as I try to exercise or move around...
@@TeddyRumble Heaven forfend. For all of the corporate/profiteer-driven hype, AI has very narrow use cases that mostly center around eliminating "grunt work" (situations that have easily-understood variables, but a LOT of them to go through). In a complex situation like this, I can guarantee an AI "decisionmaker" would have killed the patient by defaulting to the most common response(s).
Many years ago, I worked in a regional medical center, not a healthcare provider though. A new nurse was assigned to an ICU, which I don’t think was a great idea. She went to give a patient Lasix. The vial looked just like the potassium vial. She gave potassium. Instant cardiac arrest. This video plugs some holes in my mind based on that.
Sorry to hear that. Potassium isn't given in a vial however. I can't speak of "many years ago" but we now give potassium over a series of small infusion bags or as a pill. Potassium is one of the drugs you never want to push quickly because of these cardiac changes he talked about. It is one of the drugs given in a lethal injection. Lasix can have the opposite effect on potassium. It can lower your potassium by causing your kidneys to discrete it in your urine. Which can also cause cardiac arrest if your potassium is too low.
Excellent video Doc! So can I assume that this was an iatrogenically induced situation? If so, glad that you were able to quickly resolve the problem and stabilize the patient! Hope that all is well and yet another video that I will have to send off to my cousin (M.D.). 👍👍
Why did you go with CaCl instead of Calcium Gluconate? Our standard protocol for hyperkalemia is Calcium Gluconate combined with Insulin/D10 and Lokelma.
My niece, 1st diagnosed with asthma as an adult, used her albuterol emergency inhaler too much & ended up in the hospital. Not sure of the details but perhaps the opposite of this patient's problem. PS i appreciate your teaching style.
I worry about my home health clients who take even temporary Furosemide. I can’t do labs at home and once a day is what I’m doing. Mostly medication reminders and blood sugar, Lantus and I am sure you see where I’m going.
That was very interesting. I actually had the opposite problem a few years ago, I had a quad bypass and the put me on (amongst other things) a diuretic post op and within a few hours of waking up (I was lying in ICU) all of a sudden I had some 20 nurses and doctors surrounding me. They said I was in A-Fib and they gave me a shot of potassium. Apparently I'm a high K emitter when on Furosemide and so for the 3 months they were trying to get me to shed excess fluid I was taking a potassium supplement. I was told that my BP was 230/190 which post bypass surgery I'm guessing made me very lucky that the stitches held mere hours after they were put in.
Nurse with 10yrs experience. Great education. I guessed insulin glusose first follow by calcium gluconate. Mostly the trio given in ED before coming to the floor. Is there a difference between choices of chloride vs gluconate in this instance?
I am guess that you get chloride is the better choice because you get 2x + charges with chloride vs one with 1x with gluconate as well as chloride is just a salt that is probably more readily available to the body?
It’s whatever is on the crash cart. Getting it from pharmacy would take too long. Generally CaCl requires a central line and Ca gluconaye doesn’t but in this case I’d use which ever I could by hands on first.
Nice one. I thought calcium right away! I always looked at a human as an ultimately electric entity. Food to chemicals, chemicals to energy in the form of charged particles... But great story!
Thx Doc, when people talk about the benefits of ‘grounding’ (walking barefoot on the earth), they suggest that if done regularly it ‘thins the blood’ as presumably it’s reducing the polarity difference between the blood cells. Based on your talk, is that a good thing or a bad thing?
Peak key waves and what else? Too much potassium, inside or outside cell? elevated potassium. electrical? peak key waves? bicarbonate? glucose? insulin? albuteral? Sodium? Calcium chloride? -- If a person has a strong crave for salty after sweets, what might that indicate?
A few weeks ago I think I got a similar heart rhythm like this, based on an Emay EMG-10 portable ECG monitor. I was water fasting and drinking a lot of electrolytes (sodium, potassium, magnesium, calcium). I was getting about 5 teaspoons of potassium bicarbonate with all that, and not drinking enough water. About 62 hours into the fast I felt my heart rhythm was off, and it seemed the EMG-10 was seeing the depolarization as a separate heart beat, based on the reading saying 120bpm when in fact it felt like my normal 60bpm I drank a few sips of coconut water and 15min it got better, but I had serious palpitations for a few weeks until I took multivitamin tablets a couple days in a row
The House series has a patient with heart problems going down the same way from eating high K content Durian fruit, and I remember it because of a Passion fruit doing it to a CHF patient.., so the compounded effect of drugs is not so strange.
The ketogenic diet has brought concern to those practicing it to increase their dietary intake or supplementation of electrolytes such as potassium. The only way I can see someone having hyperkalemia is by supplementation.
If the patient had progressed to cardiac arrest, cardiac recovery would still have depended on restoring the correct charge gradient otherwise you're just in the same situation that brought on the arrest. In other words, if you hadn't correctly "guessed" hyperkalemia, the patient would have progressed to cardiac arrest and likely have died. Is that your take on this case? Just wondering as a lay person...
Yes. The importance of quickly identifying the cause of the peak t waves but also the understanding of knowing what the fastest intervention would be were the two keys in this case
Soon, the good doctor's knowledge will be at every practitioner's fingertips. A.I. will give even the most incompetent doctor the knowledge of the best doctor in the field. Count on it.
@@bobthrasher8226 that will not be the case. AI is used already to spot tumors in mammogram studies, and it is much more accurate than humans. AI is simply a tool.
This story sounds familiar. Have you told it before in the last couple years? Or maybe it's common and I saw it on another video. I've watched a lot of videos about cardiac arrest after I had a 40 minute cardiac arrest in 2019. It happened during a heart attack caused by an in-stent thrombosis 6.5 years after placement, but they never figured out what triggered it. After watching videos about blood chemistry, I wonder if eating corned beef and cabbage, potatoes, and carrots for dinner might have played a role.
I'm trying to understand why calcium administration would help hyperkalemia, I don't follow why it would stabilize the action potential. Seems to me the answer might be "Plasma levels of both norepinephrine and epinephrine and the metabolites normetanephrine and dihydroxyphenyl-glycol were significantly higher in the hypercalcemic group than in the other two groups" ie hypercalcemia raises adrenaline, which ramps up the sodium potassium pump. Snippet from Sympathetic system function and vascular reactivity in hypercalcemic patients, 1982 I guess if the doctor doesn't know that the peaked t wave means hyperkalemia the patient would be screwed. Btw Etomidate suppresses cortisol, which may be the source of the hyperkalemia.
Etomidate rarely causes hyperkalemia in my experience and it’s not listed as a side effect. Besides, aldosterone from the adrenal gland governs potassium far more than cortisol from the same.
Seems there should be more investigation in viroporins, and the effects on electrolyte homeostasis. Did anyone look at this during covid? The membrane transfer of viral and self, this fusion, ya, I think it can be detrimental especially in the heart!
While much of this material is relevant, I don't see a specific video on hypokalemia. Perhaps some day? :) I ran into trouble a few weeks ago, and developed a ventricular arrhythmia that put me in the ER. Upon arrival, my K was 3.3, not stupidly low, but apparently low enough to produce serious effects. Despite deliberately eating a lot of high potassium food, I apparently ran my levels low with several consecutive days of modest sunset walking / (very light hiking) in the Arizona desert. I've done this for many year and never had an overt issue. Na was also a little below normal range. Thanks again for your videos!
As a Layman listening, I feel like I’m missing something: What was the reason that patient came in and was intubated in the first place? Is this an overdose situation or something like that? Whats the backstory?
So this was a patient that was developmentally delayed and had multiple medical issues and had come in for respiratory failure from the pneumonia. The reason for his elevated potassium was likely related to that but also could’ve been kidney issues as well. It was 15 years ago.
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I just got home from 7 days in the ICU yesterday and came close to cardiac arrest twice. They call it "rapid response team" when you are about to code. My problem was pneumonia caused by the flu and caused my arterial oxygen to drop into the 60’s which is very bad. I had great team of doctors who pulled me through the illness.
Outstanding. Sounds like you had a great team!
This is the best channel not only on RUclips, but on the internet.
This doctor is a Godsend, it's as simple as that
This happened to me a little over 20 years ago. I had been through a massive trauma that broke many bones and caused extensive internal damage. Two weeks after I was put under for another procedure (using succ) and went into cardiac arrest. For over 30 minutes attempts were made for resuscitation which included cracking my chest and hand massaging / shocking my heart. What surprised many medical people and myself was that I had no heart or brain damage. The Chief of Anesthesiology visited me and explained in a manner similar to this vid. Thanks for the video.
You are a walking miracle.
This is THE BEST video I've ever seen on a doctor's preemptive actions to prevent a life-threatening emergency to a patient.
Man… we need more doctors like you. You saved this man’s life. So taking to much albuterol can cause this or would it actually reduce your potassium? When I had Covid I was taking albuterol like crazy. I’m talking every 4 hours like clockwork because I just couldn’t breathe. My potassium came back slightly lower than normal but doctor wasn’t concerned.
Taking albuterol can actually reduce your potassium
Advair and Albuterol put me in the ER post covid for hypokalaemia.
@@ZzTop-vj5wo yikes!! I’m sorry to hear that. How are you doing now? I honestly think I was headed in that direction. I was taking trelegy and duoneb like an idiot and my pulmonologist said that was like double treatment and I should stop immediately switch to albuterol but the shortness of breath was so bad I just wanted relief. I haven’t been 100 percent since that day.
Interesting, thanks. You explain so that even lay people can understand what happened. 🙂
I haven’t seen a video of yours since knee deep in Covid. ❤ stay well.
Good job……
no doctor in Sweden thinks this way, they do not do anything quickly and a dead patient is one less worry and hardwork to handle... every doctor I met here is gaslighting you from start to finish and you get just more and more sick,... is amazing doctors like this one even exist.. I can hardly walk up without pressue on my heart, getting all sweaty and feel like there is a stone in my heart and cramp in my left arm all the time , and shoulder and heart rate go up to 150-180 from just simple walking in stairs or out in the park.... feels like passing out with a wrench around the heart and hard to breath as soon as I try to exercise or move around...
It sounds like it's quite hard for any doctor to do anything for you.
Pls check with an EP electrophysiologist Cardio, for possible Afib, need meds
socialized medicine huh?
It's the same in the USA. My son died because of hospital neglect and many medical mistakes.
Just perfect and helpful 👌🏼 ❤️ I'm an EMT who worked in icu
And this is what exactly every nurse should know. Thank you sir!
Glad it was helpful!
Thanks for refreshing my knowledge 😊🙏
Amazing work. You always hope your doctor is this hyper competent in a dire situation.
Soon, A.I. will be in every doctor's armamentarium.
@@TeddyRumble Heaven forfend. For all of the corporate/profiteer-driven hype, AI has very narrow use cases that mostly center around eliminating "grunt work" (situations that have easily-understood variables, but a LOT of them to go through). In a complex situation like this, I can guarantee an AI "decisionmaker" would have killed the patient by defaulting to the most common response(s).
@@darkarima you're wrong.
Many years ago, I worked in a regional medical center, not a healthcare provider though. A new nurse was assigned to an ICU, which I don’t think was a great idea. She went to give a patient Lasix. The vial looked just like the potassium vial. She gave potassium. Instant cardiac arrest. This video plugs some holes in my mind based on that.
Yikes. Thanks
Sorry to hear that. Potassium isn't given in a vial however. I can't speak of "many years ago" but we now give potassium over a series of small infusion bags or as a pill. Potassium is one of the drugs you never want to push quickly because of these cardiac changes he talked about. It is one of the drugs given in a lethal injection.
Lasix can have the opposite effect on potassium. It can lower your potassium by causing your kidneys to discrete it in your urine. Which can also cause cardiac arrest if your potassium is too low.
I have seen that, the colour of the viles were both yellow
Thank God you are here helping us understand.
Wow !!! Amazing fast thinking !!!
Excellent video Doc! So can I assume that this was an iatrogenically induced situation? If so, glad that you were able to quickly resolve the problem and stabilize the patient! Hope that all is well and yet another video that I will have to send off to my cousin (M.D.). 👍👍
You're a great doctor!
Awesome presentation as always!!! Continue more like this!!! Thank you!
Thank you! Will do!
Thank u Doc for sharing!
Nicely done Dr. Thanks
Excellent. Thank you.
Thanks again.
BTW, so glad I'm still in the control group.
Why was he given succinylcholine if his blood potassium was already too high at 6.0?
Thank you for the video and experience Dr.
can you make a video on hypokalemic effects?
Yes! We actually did as part of our basic metabolic panel course on our website at medcram.com.
I’ll have to revisit it.
@@Medcram yes, thank you
Why did you go with CaCl instead of Calcium Gluconate? Our standard protocol for hyperkalemia is Calcium Gluconate combined with Insulin/D10 and Lokelma.
My niece, 1st diagnosed with asthma as an adult, used her albuterol emergency inhaler too much & ended up in the hospital. Not sure of the details but perhaps the opposite of this patient's problem. PS i appreciate your teaching style.
What put the patient into the elevated potassium situation (i.e. when he walked in) in the first place??
Good question. I wondered that too.
Can’t remember in that case in particular but it is usually a combination of acidosis, acei etc.
Also calcium chloride contains 3 times as much calcium than calcium gluconate. I tend to get the two confused but is important to differentiate.
I worry about my home health clients who take even temporary Furosemide. I can’t do labs at home and once a day is what I’m doing. Mostly medication reminders and blood sugar, Lantus and I am sure you see where I’m going.
My daughter is on 10mg a day for inter cranial pressure and has been for years. Is she in danger?
That was very interesting. I actually had the opposite problem a few years ago, I had a quad bypass and the put me on (amongst other things) a diuretic post op and within a few hours of waking up (I was lying in ICU) all of a sudden I had some 20 nurses and doctors surrounding me. They said I was in A-Fib and they gave me a shot of potassium. Apparently I'm a high K emitter when on Furosemide and so for the 3 months they were trying to get me to shed excess fluid I was taking a potassium supplement. I was told that my BP was 230/190 which post bypass surgery I'm guessing made me very lucky that the stitches held mere hours after they were put in.
Hi, doc! What dose did you give in this instance?
Nurse with 10yrs experience. Great education. I guessed insulin glusose first follow by calcium gluconate. Mostly the trio given in ED before coming to the floor. Is there a difference between choices of chloride vs gluconate in this instance?
I am guess that you get chloride is the better choice because you get 2x + charges with chloride vs one with 1x with gluconate as well as chloride is just a salt that is probably more readily available to the body?
It’s whatever is on the crash cart. Getting it from pharmacy would take too long.
Generally CaCl requires a central line and Ca gluconaye doesn’t but in this case I’d use which ever I could by hands on first.
@@Medcram thank you for the reply. Your nurses are fortunate to have you at the bedside, thanks for the education.
What do you do to your teeth to make them look so white and healthy?
Nice one. I thought calcium right away! I always looked at a human as an ultimately electric entity. Food to chemicals, chemicals to energy in the form of charged particles... But great story!
Why was this patient intubated with sux? Was it simply that labs weren't yet available when the pt needed an airway?
Thx Doc, when people talk about the benefits of ‘grounding’ (walking barefoot on the earth), they suggest that if done regularly it ‘thins the blood’ as presumably it’s reducing the polarity difference between the blood cells. Based on your talk, is that a good thing or a bad thing?
OK I'm moving to California.
Peak key waves and what else? Too much potassium, inside or outside cell?
elevated potassium. electrical? peak key waves? bicarbonate? glucose? insulin? albuteral?
Sodium? Calcium chloride?
-- If a person has a strong crave for salty after sweets, what might that indicate?
So he started at 6.0mmol/L. What do you think it was by the time his heart rate was getting so low as a result of that medication?
7+. However it’s not just the level but how fast it gets there.
high potassium causes bradycardia
@@Medcram I was just wondering, as my recent labs were 6.3 and the doctors were concerned. Although I had no symptoms.
A few weeks ago I think I got a similar heart rhythm like this, based on an Emay EMG-10 portable ECG monitor. I was water fasting and drinking a lot of electrolytes (sodium, potassium, magnesium, calcium). I was getting about 5 teaspoons of potassium bicarbonate with all that, and not drinking enough water. About 62 hours into the fast I felt my heart rhythm was off, and it seemed the EMG-10 was seeing the depolarization as a separate heart beat, based on the reading saying 120bpm when in fact it felt like my normal 60bpm
I drank a few sips of coconut water and 15min it got better, but I had serious palpitations for a few weeks until I took multivitamin tablets a couple days in a row
❤❤❤
The House series has a patient with heart problems going down the same way from eating high K content Durian fruit, and I remember it because of a Passion fruit doing it to a CHF patient.., so the compounded effect of drugs is not so strange.
How to contact you doctor
So I have been taking potassium supplements, is that not a good idea?
It might be for you. Especially if you are on a medication that reduces potassium such as lasix. Have it checked.
Why would it leave behind a negative charge if it's "trying" to achieve equilibrium?
Potassium equilibrium creates a negative intracellular charge.
The ketogenic diet has brought concern to those practicing it to increase their dietary intake or supplementation of electrolytes such as potassium. The only way I can see someone having hyperkalemia is by supplementation.
So why he had high Potassium? From supplements ?
No. Likely renal.
How much Albuterol would you order?
A “unit dose breathing treatment”
If the patient had progressed to cardiac arrest, cardiac recovery would still have depended on restoring the correct charge gradient otherwise you're just in the same situation that brought on the arrest. In other words, if you hadn't correctly "guessed" hyperkalemia, the patient would have progressed to cardiac arrest and likely have died. Is that your take on this case? Just wondering as a lay person...
Yes. The importance of quickly identifying the cause of the peak t waves but also the understanding of knowing what the fastest intervention would be were the two keys in this case
Soon, the good doctor's knowledge will be at every practitioner's fingertips. A.I. will give even the most incompetent doctor the knowledge of the best doctor in the field. Count on it.
@@TeddyRumble It depends on AI's training. Imagine AI trained to only use pharma approved protocols....
@@bobthrasher8226 that will not be the case. AI is used already to spot tumors in mammogram studies, and it is much more accurate than humans. AI is simply a tool.
This story sounds familiar. Have you told it before in the last couple years? Or maybe it's common and I saw it on another video. I've watched a lot of videos about cardiac arrest after I had a 40 minute cardiac arrest in 2019. It happened during a heart attack caused by an in-stent thrombosis 6.5 years after placement, but they never figured out what triggered it. After watching videos about blood chemistry, I wonder if eating corned beef and cabbage, potatoes, and carrots for dinner might have played a role.
Not sure I’ve been a story on this before I doubt it. Not sure about the question at the end too.
I'm trying to understand why calcium administration would help hyperkalemia, I don't follow why it would stabilize the action potential. Seems to me the answer might be
"Plasma levels of both norepinephrine and epinephrine and the metabolites normetanephrine and dihydroxyphenyl-glycol were significantly higher in the hypercalcemic group than in the other two groups" ie hypercalcemia raises adrenaline, which ramps up the sodium potassium pump. Snippet from
Sympathetic system function and vascular reactivity in hypercalcemic patients, 1982
I guess if the doctor doesn't know that the peaked t wave means hyperkalemia the patient would be screwed.
Btw Etomidate suppresses cortisol, which may be the source of the hyperkalemia.
Etomidate rarely causes hyperkalemia in my experience and it’s not listed as a side effect. Besides, aldosterone from the adrenal gland governs potassium far more than cortisol from the same.
Succinylcholine is known to increase potassium leakage, so it may have been the combination of the two
How about giving Mg+?
Interesting thought. Much more effective in ventricular arrhythmias such as torsades de points.
Seems there should be more investigation in viroporins, and the effects on electrolyte homeostasis. Did anyone look at this during covid? The membrane transfer of viral and self, this fusion, ya, I think it can be detrimental especially in the heart!
This happened 15 years ago
A.I. will soon be advising doctors, no matter their level of expertise. Many lives will be saved.
While much of this material is relevant, I don't see a specific video on hypokalemia. Perhaps some day? :)
I ran into trouble a few weeks ago, and developed a ventricular arrhythmia that put me in the ER. Upon arrival, my K was 3.3, not stupidly low, but apparently low enough to produce serious effects. Despite deliberately eating a lot of high potassium food, I apparently ran my levels low with several consecutive days of modest sunset walking / (very light hiking) in the Arizona desert. I've done this for many year and never had an overt issue. Na was also a little below normal range.
Thanks again for your videos!
Thanks! We did a video as part of the bmp series.
@@Medcram I'll look it up. Thanks.
As a Layman listening, I feel like I’m missing something: What was the reason that patient came in and was intubated in the first place?
Is this an overdose situation or something like that? Whats the backstory?
So this was a patient that was developmentally delayed and had multiple medical issues and had come in for respiratory failure from the pneumonia. The reason for his elevated potassium was likely related to that but also could’ve been kidney issues as well.
It was 15 years ago.
Abab
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