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I want this guy to be MY doctor. Brilliant, practical, and he has integrated a vast wealth of knowledge into a systematic approach. Wow!

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 is the best channel not only on KZfaq, but on the internet.

This is THE BEST video I've ever seen on a doctor's preemptive actions to prevent a life-threatening emergency to a patient.

I haven’t seen a video of yours since knee deep in Covid. ❤ stay well.

This doctor is a Godsend, it's as simple as that

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.

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...

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.

Interesting, thanks. You explain so that even lay people can understand what happened. 🙂

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.

Good job……

Outstanding 👍👍👍

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.). 👍👍

Just perfect and helpful 👌🏼 ❤️ I'm an EMT who worked in icu And this is what exactly every nurse should know. Thank you sir!

Thanks for refreshing my knowledge 😊🙏

Thank God you are here helping us understand.

Wow !!! Amazing fast thinking !!!

Nicely done Dr. Thanks

Awesome presentation as always!!! Continue more like this!!! Thank you!

You're a great doctor!

Excellent. Thank you.

Amazing work. You always hope your doctor is this hyper competent in a dire situation.

Thanks again. BTW, so glad I'm still in the control group.

Thank you for the video and experience Dr. can you make a video on hypokalemic effects?

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.

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

What put the patient into the elevated potassium situation (i.e. when he walked in) in the first place??

OK I'm moving to California.

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 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.

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.

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!

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.

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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?

What do you do to your teeth to make them look so white and healthy?

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?

Why would it leave behind a negative charge if it's "trying" to achieve equilibrium?

How much Albuterol would you order?

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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?

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!

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...

So why he had high Potassium? From supplements ?

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.

So I have been taking potassium supplements, is that not a good idea?

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.

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?

How about giving Mg+?

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!

A.I. will soon be advising doctors, no matter their level of expertise. Many lives will be saved.

Abab