For a patient with hyperkalemia, what is the first step you should take?

In the scenario of a patient with hyperkalemia, the correct first step is to check the EKG. Hyperkalemia can have significant effects on the heart, particularly by causing changes in the cardiac conduction system, which can lead to life-threatening arrhythmias. Assessing the EKG allows healthcare providers to identify these changes—such as peaked T-waves, widened QRS complexes, or even a sine-wave pattern—which are critical for determining the urgency of treatment needed.

Once the EKG is evaluated, appropriate interventions can be initiated based on the findings. For example, if there are significant EKG changes, immediate therapeutic measures, such as administering calcium gluconate or insulin, may be warranted to stabilize the heart and lower potassium levels. However, failing to check the EKG first could lead to overlooking potentially serious cardiac complications.

Subsequent choices, like administering insulin, providing potassium, or starting dialysis, may be necessary depending on the severity of hyperkalemia and the EKG findings, but they follow the critical step of assessing the cardiac status.