There was discussion on blood products and patient's significant blood loss during the extraction. While carrying blood products would be difficult and obviously have associated obstacles. Has there been any consideration for TXA in your HERT kit?
When discussing the fluid choice it was stated that lactated ringers was not given due to fear of causing hyperkalemia. Lactated ringers does include 4 mEq/L of potassium. One would think that giving a patient with hyperkalemia additional potassium would worsen the hyperkalemia however this is not correct. Even if the patient has hyperkalemia the concentration of potassium in lactated ringers would be lower than the patient's potassium concentration. Administering lactated ringers to a patient with hyperkalemia will bring the patient's potassium towards 4 mEq/L and decrease the potassium level. Additionally, lactated ringers may be a better choice when compared to normal saline. Normal saline causes a non-anion gap metabolic acidosis which shifts potassium out of cells thereby increasing the potassium level. This effect is not seen with lactated ringers. Good Pulmcrit article explaining this: https://emcrit.org/pulmcrit/myth-busting-lactated-ringers-is-safe-in-hyperkalemia-and-is-superior-to-ns/
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Nicholas L. - April 15, 2019 4:19 AM
There was discussion on blood products and patient's significant blood loss during the extraction. While carrying blood products would be difficult and obviously have associated obstacles. Has there been any consideration for TXA in your HERT kit?
Castrenze F. - April 17, 2019 2:47 PM
When discussing the fluid choice it was stated that lactated ringers was not given due to fear of causing hyperkalemia. Lactated ringers does include 4 mEq/L of potassium. One would think that giving a patient with hyperkalemia additional potassium would worsen the hyperkalemia however this is not correct. Even if the patient has hyperkalemia the concentration of potassium in lactated ringers would be lower than the patient's potassium concentration. Administering lactated ringers to a patient with hyperkalemia will bring the patient's potassium towards 4 mEq/L and decrease the potassium level. Additionally, lactated ringers may be a better choice when compared to normal saline. Normal saline causes a non-anion gap metabolic acidosis which shifts potassium out of cells thereby increasing the potassium level. This effect is not seen with lactated ringers.
Good Pulmcrit article explaining this: https://emcrit.org/pulmcrit/myth-busting-lactated-ringers-is-safe-in-hyperkalemia-and-is-superior-to-ns/