Electrolyte and metabolic management
›Hyperkalemia treatment pathway if ECG changes or potassium 6.5 mmol/L or higher
›Calcium gluconate IV
›10 mL of 10 percent solution over 5 to 10 minutes adult
›Repeat dose if persistent ECG instability
›Insulin regular IV
›10 units IV adult
›Dextrose 25 g IV if glucose below 13.9 mmol/L
›Glucose checks at 0, 30, 60, 120 minutes
›Albuterol nebulized
›10 to 20 mg nebulized adult
›Tachycardia limitation
›Sodium bicarbonate IV
›Consider if metabolic acidosis with pH below 7.2
›Avoid if volume overloaded and sodium load concern
›Potassium removal
›Loop diuretic only if volume overloaded and producing urine
›Dialysis trigger if refractory or severe AKI
›Calcium management principles
›Avoid empiric calcium replacement unless symptomatic hypocalcemia
›Treat symptomatic hypocalcemia with IV calcium
›Etiology specific actions
›Heat stroke suspected
›Active cooling immediately
›Target temperature below 39 C as soon as feasible
›Seizure related
›Seizure control and workup
›Aspiration risk mitigation
›Drug induced
›Stop offending agent
›Toxicology consult as needed
›Suspected NMS or serotonin syndrome
›Stop serotonergic or dopamine antagonist agents
›Benzodiazepines for agitation
Compartment syndrome pathway
›Limb threat management
›Immediate surgical consultation for high suspicion
›Remove constrictive dressings
›Limb at heart level
›Compartment pressure measurement if diagnosis unclear
Monitoring and reassessment loop
›Reassessment cadence
›Vitals every 15 to 30 minutes if unstable
›Lung exam after each bolus
›Repeat electrolytes every 2 to 4 hours if severe
›Repeat CK every 6 to 12 hours early trend
›Urine output hourly tracking
›Early consult triggers
›Nephrology for rising creatinine with oliguria
›ICU for refractory hyperkalemia or shock
›Surgery for compartment syndrome concern
›Toxicology for suspected toxin mediated syndrome