Electrolyte
ACP: Cardiac arrest due to suspected hyperkalemia (e.g., renal failure, diabetic ketoacidosis)
ACP: Suspected hyperkalemia with cardiovascular toxicity (e.g., wide QRS complexes, peaked T waves, or hemodynamic instability)
ACP: Calcium channel blocker overdose with symptomatic bradycardia or hemodynamic instability
Calcium shall not be routinely given in cardiac arrest in the absence of evidence of hyperkalemia
ACP: All indications
ACP: Cardiac arrest
ACP: All other causes
Calcium is essential for a wide range of biological processes, including nerve conduction, muscle contraction, renal function, and coagulation. Administration of calcium in prehospital contexts is intended to improve myocardial contractility and ventricular automaticity.
Intravenous administration of calcium is completely absorbed by the body. It is rapidly incorporated into skeletal muscle and distributed evenly between intra- and extracellular fluids.
Tissue irritation is the most common side effect of calcium administration. Hypotension, cardiac arrhythmias, and cardiac arrest may occur if calcium is given too quickly. Calcium chloride may precipitate or worsen acidosis, cor pulmonale, or renal and respiratory diseases.
Do not administer calcium IM or SC. Extravasation of calcium can cause tissue necrosis.
Flush IV lines well prior to or following sodium bicarbonate administration to avoid development of calcium carbonate precipitate.
Patients taking digoxin and receiving calcium are at elevated risk for the development of arrhythmias.