CAUTION: THESE NOTES CONTAIN SPOILERS!!!

Case Introduction

EMS brings in an elderly man who has fallen…

Initial Vitals

* Temp 98.6* HR 58* RR 16* BP 105/60* 99%

Critical Actions

* Treat the patient’s pain* Consult orthopedics for a hip fracture* Obtain an EKG* Treat Severe Hyperkalemia* Consult nephrology for dialysis

Final Diagnosis

Ground level fall resulting in hip fracture, missed dialysis, and severe hyperkalemia

Tips and Tricks

Patient’s will frequently have more than one final diagnosis. Do not prematurely close an the initial, obvious, diagnosis.

A man can have as many diseases as he damn well pleases! Hickam’s dictum

Additional Reading

* Basic approach to hyperkalemia (EM Clerkship)* EKG manifestations of hyperkalaemia (LITFL)