Another piece for the V&A, this made entirely from cutlery (I am drawing a long bow for today’s post)
Here is another case in this sporadic series
Some months ago I looked after a young patient who had been retrieved following a machete injury near the shoulder, resulting in almost total amputation of the arm. The injury had occurred some hours previously, with the patient left at the side of the road.
He had been intubated by the retrieval team at the scene.
On arrival to the Emergency Department his potassium level was 6.5 mmol/L
Normal serum potassium rise following an intubating dose of suxamethonium is 1.5mmol/L TRUE/FALSE
ECG changes associated with hyperkalaemia include tall peaked T waves and a shortened PR interval. TRUE/FALSE
He was taken to theatre to reattach the arm. He was hypovolaemic and anuric.
I set about trying to lower his serum potassium and restore his blood volume.
Salbutamol may be detected as halothane when nebulised within the circle circuit TRUE/FALSE
Calcium gluconate is used in the management of hyperkalaemia as it lowers serum potassium TRUE/FALSE
Hyperkalaemia and hypercalcaemia are potential metabolic consequences of massive transfusion TRUE/FALSE
To be honest, nothing I tired (and I tried a lot of everything I could think of, short of starting dialysis) lowered his potassium at all. But at least it didn’t increase any further. He survived the reimplantation and was transferred to ICU for further management, including some much needed haemodialysis.