Hemodialysis Patient

BLS

• Ensure patent airway

• O2 saturation

• Give O2 to maintain SpO2 at 94-98%

• Ventilate PRN

ALS

• Monitor/ECG

• Determine time of last dialysis

• IV in upper extremity without working graft/AV fistula

For immediate life threat only

• EJ/IO access preferred over accessing percutaneous dialysis catheter (e.g., Vascath) or shunt/graft

• Monitor and administer via existing dialysis catheter (aspirate 5 mL prior to infusion*)

  OR

• Access graft/AV fistula

*Dialysis catheters contains concentrated dose of heparin which must be aspirated prior to infusion

Fluid overload with rales

• Treat CHF per Respiratory Distress Protocol

Suspected hyperkalemia (e.g., peaked T-waves or widened QRS complex)

• Obtain 12-lead ECG

• If widened QRS complex, immediately administer CaCl2 1 gm IV/IO

• NaHCO3 1 mEq/kg IV/IO

• Continuous albuterol/levalbuterol 6 mL via nebulizer

For patients not on hemodialysis with suspected hyperkalemia

• Obtain 12-lead ECG

• If findings consistent with hyperkalemia (e.g., peaked T-waves or widened QRS complex), contact base hospital

Hyperkalemia patients may be asymptomatic or report the following:

• Generalized fatigue

• Weakness

• Paresthesias

• Paralysis

• Palpitations

• Hypotension

finish

finish