Transcript AEMT Transition - Unit 32

TRANSITION SERIES
Topics for the Advanced EMT
CHAPTER
32
Renal Disorders
Objectives
• Discuss the frequency rates for renal
diseases in the U.S.
• Review basic renal physiology.
• Discuss pathophysiology of renalrelated disorders.
• Review basic assessment and
management strategies.
Introduction
• Renal disorders are those that pertain
to the kidneys.
• Potentially painful or fatal
pathophysiologic changes can occur
with renal diseases.
Epidemiology
• Renal diseases affect about 20 million
people in the United States.
• 350,000 Americans receive dialysis for
end-stage renal disease.
• 50,000 people die each year from
kidney disease.
Pathophysiology
• Kidneys
– Production and elimination of urine
– Maintain electrolyte balance
– Contribute to the body's pH
Pathophysiology (cont’d)
• Kidneys (continued)
– Can be damaged by traumatic or
nontraumatic etiologies.
 Inflammation
 Infection
 Obstruction
 Hemorrhage
Pathophysiology (cont’d)
• Renal conditions
– Kidney stones
– Kidney failure
– Dialysis-related emergencies
Pathophysiology (cont’d)
• Renal conditions – kidney stones
– Crystals that form in the kidneys that
may obstruct urine flow or get trapped
in the ureters or urethra
Sectioned kidney with kidney stones. (© SIU/Photo Researchers, Inc.)
Pathophysiology (cont’d)
• Renal conditions – renal failure
– Acute renal failure
 Occurs over a period of days
 Can result in serious metabolic
derangements
– Chronic renal failure
 Occurs over a period of years
 Permanent loss of nephrons
 Waste products will accumulate
Pathophysiology (cont’d)
• Renal conditions – dialysis
– Artificial process used to remove water
and waste from the body due to CRF or
ARF
– Two types
 Hemodialysis
 Peritoneal dialysis
Assessment Findings
• General assessment considerations
– Dialysis patients are often on heparin;
falls can result in serious bleeding.
– Ask patient about use of dialysis.
– Ask about changes to urine.
– Ask about shunt or graft placements.
– Ask about other medical problems.
Assessment Findings (cont’d)
• General assessment findings
– Abnormal urination (odor, color)
– Abdominal or flank pain
– Fever, malaise, nausea, vomiting
– Pain or burning during sex
– Increased urge to urinate
– Hematuria, oliguria
– Anorexia, tachycardia
Assessment Considerations
• Do not obtain a blood pressure in an
arm with a dialysis shunt or fistula.
• Do not establish intravenous access in
an arm with a dialysis shunt or fistula.
• Palpation of the abdomen commonly
elicits pain.
Patients who experience a renal emergency may complain of abdominal,
flank, or lower back pain, or tenderness on palpation.
Emergency Medical Care
• Ensure airway adequacy.
• Provide oxygen based on need.
– Apply oxygen to keep SpO2 >95%.
– NRB or PPV based on breathing
adequacy.
• Control external hemorrhage if present.
Emergency Medical Care (cont’d)
Place patient in position of comfort.
Calm and reassure the patient.
Initiate transport.
If you choose to initiate intravenous
access, do so en route to the hospital.
• Continuously monitor and reassess.
•
•
•
•
Case Study
• You are dispatched to a local
construction site for someone with
abdominal pain. Upon your arrival, you
are directed to a big burly man who is
sitting on a chair, all hunched over. As
you approach he stands up and starts
walking, but then sits down again. He
looks at you and says, “Help me man, I
can‘t get comfortable – my belly is on
fire!”
Case Study (cont’d)
• Scene Size-Up
– Scene is safe.
– Standard precautions taken.
– Patient is 32 years old, male, 240 lbs.
– Entry and egress from site is
unobstructed.
– NOI appears to be back pain.
– No additional resources needed.
Case Study (cont’d)
• Primary Assessment Findings
– Patient alert and well oriented.
– Airway patent.
– Breathing normally, talks in full
sentences.
– Peripheral perfusion intact.
– Primary complaint is for severe
abdominal pain.
Case Study (cont’d)
• What kind of differentials could you
consider at this time?
• What care should be provided at this
time?
Case Study (cont’d)
• Medical History
– Patient has no medical history.
– Stated he was “going to pee” when the
pain started in his back.
• Medications
– None
• Allergies
– None
Case Study (cont’d)
• Pertinent Secondary Assessment
Findings
– Pupils equal and reactive, membranes
moist.
– Airway patent and breathing normal but
fast.
Case Study (cont’d)
• Pertinent Secondary Assessment
Findings
– Perfusion intact and strong, pulse fast.
– No history of trauma or similar incident.
– Back pain happened suddenly, rated as
“10.”
Case Study (cont’d)
• Pertinent Secondary Assessment
Findings (continued)
– States pain has traveled to his groin; he
also tells you he “peed blood twice
today.”
– PMS present times 4, SpO2 98% on
room air.
– BGL normal, no other contributory
findings.
Case Study (cont’d)
• What may be the cause of the back
pain?
• What other dangerous process could be
going on here?
• What would be three assessment
findings that could confirm your
suspicion?
Case Study (cont’d)
• Care provided:
– Patient placed on low-flow oxygen.
– Placed in the most comfortable position
attainable on wheeled cot.
– Transport initiated to ED.
– Established intravenous access.