RENAL & HEMATOLOGY EMERGENCIES JEFF SIMONS B.S. F-PC

Transcription

1 RENAL & HEMATOLOGY EMERGENCIES JEFF SIMONS B.S. F-PC

2 GOALS Overview of renal system anatomy / physiology Discuss common medical / trauma renal issues Identify associated assessment keys

3 GOALS Introduction to hematology Discuss common blood disorders and their treatments Blood transfusion collection / administration Discuss basic lab values

4 ASSESSMENT Systematic approach Appearance Auscultation Palpation Obtaining a full history Surgeries Recent changes Description of pain Secondary symptoms (Pearson, 2012)

5 RENAL SYSTEM Kidney Locations Retroperitoneal space Surrounds great vessels Function Filtration Waste elimination Electrolyte balance

6 CROSS SECTION

7 ENHANCE

8 ENHANCE ENHANCE

9 ENHANCE ENHANCE ENHANCE

10 RENAL FAILURE Types of renal failure Acute Chronic

11 ACUTE RENAL FAILURE Three categories Prerenal Intrarenal Postrenal

12 PRERENAL ACUTE FAILURE Causes Hypoperfusion of the kidneys Assessment Keys Dizziness Hypotension Tachycardia Thirst Treatment Treat underlying causes Restore blood flow

13 INTRARENAL ACUTE FAILURE Internal damage to kidney Golmeruli capillaries Kidney tubules Renal parenchyma Causes Immune mediated disease Toxins Inerstitial nephritis

14 INTRARENAL ACUTE FAILURE Signs and Symptoms Flank pain Joint pain Hypertension Headache Confusion Seizures Oliguria

15 INTRARENAL ACUTE FAILURE Treatment Removal of toxins Balance of electrolytes Fluids

16 POSTRENAL ACUTE FAILURE Obstruction of urine outflow Blockage of urethra Shutdown of nephrons

17 POSTRENAL ACUTE FAILURE Signs and symptoms Pain Groin Lower Flank Genitalia Oliguria Bladder distention Hematuria Edema

18 POSTRENAL ACUTE FAILURE Progression Hyperkalemia Acidosis Arrhythmias Cardiac arrest (Core EM, 2018)

19 ACUTE KIDNEY STONES Develop in renal pelvis Crystallization of insoluble salts or uric acid in urine Causes Poor hydration Frequent urinary tract infections Frequent catheterizations Associated with gout (Crosta, 2017)

20 KIDNEY STONES Signs and Symptoms Rapid onset pain Groin Lower Flank Genitalia Guarding Treatments Fluids Naturally passed Surgical intervention

21 CHRONIC RENAL FAILURE Irreversible impairment of nephrons Causes Diabetes Hypertension Congenital disorders Prolonged pyelonephritis

22 CHRONIC RENAL FAILURE Signs and symptoms Lethargy Nausea Headaches Cramps Altered mental status Electrolyte imbalance

23 CHRONIC RENAL FAILURE Treatments Supportive care similar to acute renal failure Dialysis Kidney transplant (Medical News Today, 2018)

24 KIDNEY TRANSPLANTATION Data as of 4/26/18 95,099 people on the kidney organ transplant list 8,509 organ transplants this year Living / deceased donors (OPTN, 2018)

25 DIALYSIS External filtration of toxins, fluid management, and restores electrolyte balance Peritoneal Dialysis Hemodialysis (Lucenxia, 2018)

26 PERITONEAL DIALYSIS Process Large amount of dialysis fluid infused into abdomen Fluid settles and exchanges toxins Drained out Risk for Peritonitis (Dreamstime, 2018)

27 HEMODIALYSIS Process Access Filtered through machine Ph Balanced Excess fluid removed Returned to Patient Required every 2-3 days (E-Health Hut, 2018)

28 HEMODALYSIS Procedure Complications Hypovolemic Shock Infection Bleeding Missed Appointments Electrolyte imbalances Fluid overload Arrhythmias / shock

29 RENAL TRAUMA Renal vascular injuries Assessment Keys Flank Pain Grey Turners sign Hematuria

30 HEMATOLOGY THE STUDY OF BLOOD

31 COMPONENTS OF BLOOD (Quora, 2018)

32 PLASMA Components Water Proteins Electrolytes Clotting factors Glucose

33 RED BLOOD CELLS (RBC) Erythrocytes Oxygen carrying capacity Hemoglobin

34 WHITE BLOOD CELLS (WBC) Leukocytes Immune response Types of WBC Monocytes Lymphocytes Neutrophils Basophils Eosinophils

35 PLATELETS Thrombocytes Function Clotting cascade

36 CLOT FORMATION (BioNinja, 2018)

37 TRANEXAMIC ACID- TXA Promotes clotting Prevents breakdown of fibrin Carried on all LifeNet Helicopters (Cohen, 2014)

38 TIME IS TISSUE Stroke Heart Attack Pulmonary Embolism DVT

39 HEMATOLOGY RELATED DISEASES Sickle Cell Hemophilia Anemia Thrombocytopenia Leukemia (Getty Images, 2018)

40 SICKLE CELL Red blood cell changes Sickle shaped Rigid Sticky Impact on body Decreased oxygen transport Anemia

41 SICKLE CELL CRISIS Inadequate blood flow to vital organs Assessment Keys Dyspnea Pain Fever Jaundice (Oneal, 2017)

42 SICKLE CELL CRISIS Treatment High flow O2 Fluids Warm compress High dose analgesia

43 HEMOPHILIA Decreased ability to form blood clots Type A Low levels of factor VIII Type B Low levels of Factor IX

44 ANEMIA Low blood count Ineffective production Blood loss Medication induced Acute / chronic in nature Assessment keys Fatigue Dyspnea Pale skin / mucus membranes

45 THROMBOCYTOPENIA Low platelet count or increased platelet breakdown Assessment Keys Abnormal Labs Bruising Excessive bleeding

46 LEUKEMIA Cancer of the blood forming tissues White blood cell abnormalities Can cause Thrombocytopenia Anemia Frequent fever & bruising

47 BLOOD TYPE AND CROSS A- Antibody B- Antibody Positive / Negative O- Universal Donor AB+ Universal Recipient

48 TRANSFUSIONS FFP Fresh Frozen Plasma PRBC- Packed Red Blood Cells Platelets Cryoprecipitate Whole Blood Transfusion Reaction

49 AMERICAN RED CROSS RedCrossBlood.org Locate donation centers or blood drives

50 BLOOD DONATION Types of collections Whole blood Power red Platelets AB elite plasma

51 WHOLE BLOOD DONATION How it works? Who are they used for? Trauma / surgical patients How long does it take? 1 hour Ideal donor blood type? All blood types

52 POWER RED DONATION How it works? Who are they used for? Trauma, newborn, sickle cell patients How long does it take? ~1.5 hours Ideal donor blood type? O+/-, A-, B-

53 PLATELET DONATION How it works? Who are they used for? Cancer / low platelet patients How long does it take? ~2.5-3 hour Ideal donor blood type? A+/-, B+, O+, AB+/-

54 AB ELITE PLASMA DONATION How it works? Who are they used for? Trauma / uncontrolled hemorrhage patients How long does it take? ~1.25 hours Ideal donor blood type? AB +/-

55 LAB VALUES Hemoglobin (HGB)- Male: Female: WBC HGB HCT PLTS

56 LAB VALUES Hematocrit (HCT)- Male: 40-50% Female: 36-46% WBC HGB HCT PLTS

57 LAB VALUES White Blood Cell (WBC)- Male: 4-11 Female: 4-11 WBC HGB HCT PLTS

58 LAB VALUES Platelets (PLTS)- 140, ,000 /ml WBC HGB HCT PLTS

59 LAB VALUES What does this all mean? Low Hgb / Hct Abnormal WBC Abnormal platelets WBC HGB PLTS HCT

60 SUMMARY Anatomy and physiology of the renal system Common acute / chronic renal failure conditions Treatments for renal failure Renal trauma

61 SUMMARY Introduction to hematology Components that make up blood Common hematological emergencies Treatment for hematological emergencies Blood product transfusion Blood donation Basic lab values

62 QUESTIONS: