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Emergency Medicine at HCMC
History and Physical
A. When is the patient scheduled for dialysis (most are M-W-F or T-Th-Sat)
and when was the last time they went to dialysis
B. Where is their access site and are there any signs of infection
C. What is the patients dry weight and what is their weight now
D. If they have missed dialysis are they SOB, any edema, any CP, HTN
on vital signs
E. What caused their renal dysfunction
F. On physical exam, pay close attention to heart, lung exam and any
signs of LE edema. Look closely at their access sight and check its patency.
Work-up (staffed prior to ordering labs)
A. Electrolytes (including Mag, Phos, Ca) are important. The fellow will
always ask you what the potassium is, if elevated make sure you have
an EKG.
B. CXR – if patient is SOB, hypoxic, or has crackles on exam
C. Many of these patients need troponin levels to be ruled out for MI
D. Get old records on all renal patients early in course of work-up.
E. Pain control – renal patients can use nitro x 3, then often
we use Dilaudid instead of MS or Demerol.
F. Fever – need blood cultures x 2 and antibiotics early, often
the first dose of antibiotics is the normal dose but remember a dialysis
patient has very poor renal drug clearance
Admission
A. Call renal fellow when you decide to admit patient and they always
want to know the potassium, Vital signs, and any signs of fluid overload.
B. Bed type is usually A6/B6 due to nursing. These patients also can
go to MICU or CCU with the renal team.
C. After you talk to the fellow you also need to talk to the renal resident.
For more information contact Richard
O. Gray MD.
Emergency
Medicine main page
Copyright © 2000 HCMC Emergency Medicine. All rights reserved.
Manual last modified: Wednesday May 07, 2003.
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