›Nebulized albuterol 10 to 20 mg
›Sodium bicarbonate IV for severe metabolic acidosis local protocol dependent
›Removal
›Emergent hemodialysis for refractory or severe hyperkalemia
›Potassium binders as adjunct only
›Monitoring
›Glucose checks every 30 to 60 minutes after insulin
›Repeat potassium in 1 to 2 hours or sooner if unstable
Volume overload and pulmonary edema
›Volume overload and pulmonary edema
›Respiratory support
›Noninvasive ventilation for acute pulmonary edema
›Escalate to intubation if failing noninvasive ventilation
›Blood pressure control when hypertensive
›Nitroglycerin SL 0.4 mg every 5 minutes up to 3 doses
›Nitroglycerin IV 10 mcg per minute
›Titration 10 mcg per minute every 3 to 5 minutes to effect
›Fluid removal strategy
›Emergent dialysis for refractory pulmonary edema
›Loop diuretic only if meaningful urine output
Sepsis and dialysis access infection
›Sepsis and dialysis access infection
›Antibiotics
›Broad coverage including MRSA and gram negative coverage
›Dose adjustment for dialysis and timing relative to dialysis
›Source control planning
›Catheter removal decision with nephrology and infectious diseases
›Drain abscess if present
›Fluids and vasopressors
›Smaller boluses with frequent reassessment in ESRD
›Norepinephrine first line for septic shock
›Culture strategy
›Peripheral blood cultures
›Catheter cultures when indicated
Peritoneal dialysis peritonitis
›Peritoneal dialysis peritonitis
›Immediate diagnostics
›Effluent cell count and differential
›Effluent culture with blood culture bottles
›Antibiotic route
›Intraperitoneal antibiotics preferred when feasible
›IV antibiotics if severe sepsis or unable to use intraperitoneal route
›Complication screening
›Severe abdominal exam findings trigger CT abdomen pelvis
›Fungal peritonitis concern triggers urgent specialist involvement
›Reassessment loop
›Timing
›Reassess every 15 to 30 minutes if unstable
›Reassess after each hyperkalemia intervention
›What to repeat
›Vitals and respiratory effort
›Mental status
›ECG if initial abnormal or symptoms persist
›Potassium trend after treatment
›Escalation triggers
›Worsening work of breathing
›New hypotension
›New arrhythmia