A 56 year old male presents to the ED with confusion and abdominal pain. You notice a fistula in his upper extremity. A tech hands you his triage ECG and you scrutinize it for the tell-tale signs of a common, life-threatening diagnosis in hemodialysis patients, while wondering what the initial steps in management are....
Everyone has seen the long list of causes of an anion gap metabolic acidosis. Why review it again? Because one day, whether in real life (or on your board exams...), thinking through this list will help make a tricky diagnosis. It is 'back to basics,' after all!
Clinical question: Does the use of contrast media in CT scans cause acute kidney injury (AKI)?
A 25 yo male with a hx of ESRD due to membranoproliferative glomerulonephritis (MPGN) presents to the ED with complaints of swelling to his LUE, face, and neck progressive over 5 days. He was seen at another ED 2 days prior and had an ultrasound of his LUE fistula as well as a duplex of his LUE which were unremarkable. A CT scan of the chest was ordered, revealing bilateral occluded brachiocephalic veins, which were treated in the interventional radiology suite with balloon venoplasty with resultant resolution of edema.
Clinical question: Does tamsulosin result in faster expulsion of symptomatic ureteral stones in patients presenting to the emergency department?
Dr. Chavez discusses pearls and pitfalls of testicular torsion.
Dr. Mansfield discussed Rhabdo
A middle-aged woman with history of unilateral nephrectomy presents with a week of malaise progressing to disorientation, and is found to have a large obstructing kidney stone in her remaining kidney coupled with signs of severe sepsis and renal failure. Read ahead for management tips and additional pearls....
It can be frustratingly difficult to obtain hemostasis in bleeding dialysis fistulas. Here are some pearls to help you next time you see this patient!
Last week we wrote about how to approach hyponatremia, the differential and signs and symptoms to watch out for. The post this week reviews the treatment of hyponatremia including the dreaded osmotic demyelination syndrome. Read on for more!
