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__NOTOC__
A 5-month-old male with complex non-syndromic craniosynostosis is
undergoing posterior cranial vault expansion and the surgeon has just raised the
scalp flap. Following a rapid bolus of packed red cells, you notice that the ECG
rhythm changes from NSR and now there are peaked T waves. What is the likely
etiology?

a) Unplugged fluid warmer

b) Accidental air embolism from improperly primed line

c) Administration of blood that has an expiration date four days from now

d) Transfusion-associated circulatory overload (TACO)

e) Administration of blood with an expiration date three weeks from now
<div class="mw-customtoggle-TYK_Answer" style="text-align: right; color:#0000ff">Click for Answer</div>
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-TYK_Answer">
==Answer==
Answer c. Hyperkalemia is a potential risk following massive transfusion,
especially in patients with small circulating blood volumes. Packed cells stored
less than one week contain < 20 mM potassium and are thus recommended in
this patient. During hyperkalemic episodes, peaked T-waves typically present
initially, followed by prolongation of the PR interval, absence of the P wave with
QRS prolongation, and eventually ventricular tachycardia and fibrillation. Packed
red blood cells are typically stored at 1-6 degrees Celcius. Significant fluid or
blood resuscitation via an unplugged fluid warmer can induce hypothermia, but
EKG changes typically include sinus bradycardia, junctional rhythm, and QT
prolongation.
==Notes==
<references />
:This question originally printed in the [http://www.amazon.com/Justin-L.-Lockman/e/B00FLG5AEE/ref=ntt_dp_epwbk_0 Pediatric Anesthesiology Review Topics] kindle book series, and appears courtesy of Naerthwyn Press, LLC.
==Keywords==
:
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