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Crush syndrome hyperkalaemia — DipIMC MCQ

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HardTraumaCrush syndrome hyperkalaemiaDipIMC

During release after prolonged crush entrapment, a patient develops bradycardia, tall T waves and QRS widening. Severe hyperkalaemia is strongly suspected and IV access is present. Which treatment has immediate priority for the ECG toxicity?

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Correct answer: B — Give IV calcium to antagonise the cardiac membrane effects

The best answer is “Give IV calcium to antagonise the cardiac membrane effects”. Severe hyperkalaemia with ECG changes threatens imminent ventricular arrhythmia. RCUK recommends IV calcium chloride, or calcium gluconate when chloride is unavailable, to antagonise myocardial toxicity. Calcium does not lower serum potassium, so insulin-glucose and adjunctive salbutamol follow to shift potassium, with removal strategies added as appropriate. A binder is too slow to protect the unstable myocardium.

Reference: Resuscitation Council UK, 2025 Special circumstances: https://www.resus.org.uk/professional-library/2025-resuscitation-guidelines/special-circumstances-guidelines