MM12: When CPR becomes DNR
MedMechanix
Ever worry about knowing when to stop the code? Today we discuss medical futility and the components that help you to recognize it. We also go through tips about talking to families, filling out the death certificate and who goes to autopsy.
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MM11: When to Admit
MedMechanix
Knowing when to admit your patient can get tricky, today we will increase your admission acumen! In this episode, we discuss 6 specific categories that can be used to help admit patients you are on the fence about. We discuss factors involved in how admission in determined and cover a few examples. Intended for medical providers in all specialties.
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MM10: All the Nausea Pathways
MedMechanix
Walk down the 4 pathways that lead to vomiting, learn to organize types of nausea, how vomiting reflex works, and explore how to choose between antiemetics.
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MM9: Do Umbrellas cause the Rain?
MedMechanix
Join us for an exploration of why COVID medical data was so confusing and tools that you can use to interpret medical testing and data. With guest Dr. Natalie Alexander, we cover the politicization of medical data, understanding what is behind medical testing, not mistaking treatment for prevention, the hierarchy of studies and more!
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MM8: OTC Med Guide
MedMechanix
Join us for a basic guide to over the counter medications for providers. We will cover cough, runny nose, allergies, acid reflux, pain, antifungals. We also go over guidelines on how to choose the right combination cold and flu medications.
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MM7: Anatomy of a CBC
MedMechanix
Dissect the anatomy of complete blood count (CBC)! Explore how to better interpret the components of cbc, which are most important and how to use them in clinical practice. We discuss the differential, left shift, bandemia, RBC morphology, hemolysis and more!
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MM6: Imaging Unzipped - Contrast
MedMechanix
Check out the second episode in unzipping the confusion of imaging studies where we explore contrast. How contrast works, the types of contrast, when to use contrast and when not to are just some of the topics discussed in this episode. We also tackle contrast allergies and contrast nephropathy with a bonus on incidental findings.
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MM5: Imaging Unzipped - Ordering Options
MedMechanix
The first of two episodes dedicated to unzip the basics of ordering medical imaging. This episode focuses on differentiating the 4 main imaging modalities, with a brief introduction on why Imaging is so dang hard and we wrap up with a quick quiz to help empower you to better understand medical imaging.
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MM4: PostOp Complications (for nonsurgeons)
MedMechanix
Today we go over common clinical post op complications with emphasis on clinical highlights for the non-surgeon providers.
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MM3: Dialysis Unzipped
MedMechanix
Unzipping the ins & outs of dialysis labs, the types of dialysis, indications for emergent dialysis, treating resistant hypertension and so much more!
info_outlineUnzipping the ins & outs of dialysis labs, the types of dialysis, indications for emergent dialysis, treating resistant hypertension and so much more!
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Hemodialysis (HD)
What it is: Dialysis machine filters the blood and excess fluid for about 4hrs typically three days a week
What you should ask: What kind of port are they dialyzing through? Is it a catheter usually located around the collar bones or do they have an AV fistula? What is their schedule for dialysis, since hemodialysis is 3 days a week, which days (MWF or TTHSat). Do you still make urine?
Pros/Cons: requires trained staff & site visit to complete, lots of fluid & diet restrictions, lots of heart strain, lower life expectancy, harder to travel
Peritoneal Dialysis (PD)
What it is: do this two ways, filtration nightly thru the patient’s own peritoneum, pt flushes dialysate fluid into their abdomen, lets it sit overnight and osmotically absorb the excess toxins, then pump out the fluid in the morning OR you can do it 5 times a day while awake without machine
What you should ask: What did your dialysate fluid look like? (Cloudy is bad, clear yellow serous fluid= okay), Did you bring your machine with you?
Pro/Con: not for morbidly obese, complex abd surgeries or noncompliant pt, longer life expectancy, more frequent sessions, better for travel, more patient responsibility
Expected Labs:
- Elevated BUN & Cr
- Hyperkalemia
- Hypoalbuminemia
- Elevated slight trop
- Anemia
- Hypocalcemia
- Hyperphosphatemia
- HTN, nephrology article
What sequelae do we need to know?
- Fluid overload
- Hyperkalemia
- Thrombosed fistula
- Bleeding fistula
- SBP
- Chest Pain during or right after
- Hypotension after - esp if took lots of fluid off quickly
- Bleeding - with uremia
How bad is it when a patient misses dialysis?
All depends on how many toxins the patient has floating around in the blood. The three we are most likely to notice:
- excess fluid, which can build up especially in third spaces and the lungs
- potassium, which can build up and cause cardiac arrhythmias
- BUN, also known as “uremia” this can cause salty skin and AMS
A build up of any of these usually means admission and emergent dialysis. In most patients this takes 2-3 weeks without dialysis to build up to any symptomatic level.
When does a patient get put on dialysis?
- No hard and fast rule
- Typical guidelines- GFR less 15-12, significant symptoms which can be earlier than 12 if have other comorbidities, repeated need for emergent dialysis
Indications for emergent dialysis
- -A acidosis ph<7.1
- -E electrolytes K>6.5
- -I Intoxication or Ingestion (alcohols & toxic drugs like lithium)
- -O overload, fluid think extreme pulm edema
- -U uremia (encephalopathy or pericarditis, etc)
What are new onset kidney failure symptoms?:
- Weakness/fatigue
- Muscle cramping
- XS or minimal urine output
- Foamy urine
- Leg or orbital edema
- N/V
- Chest pain
- Itching
About kidney transplants:
- lasts about 15 years
- Average wait time for a transplant is 5 years
- Cellcept & tacrolimus r immune suppressing drugs to prevent rejection
- transplant surgeons don’t see their patients after the first year or two
CKD & Dialysis Statistics if you are interested.
As promised: the Dialysis PDF handout.