In residency and med school we are always taught the indications for emergent CRRT as the mnemonic: AEIOU Acidosismetabolic acidosis with a pH < 7.1 Electrolytes hyperkalemia > 6.5 mEq/L refractory to treatment or rapidly rising levels in potassiumIngestionswith dialyzable drug, including salicylates, lithium, isopropanol, methanol, and ethylene glycol (SLIME)Overloadvolume overload that does not respond […]
Read More Only the A-E-I-O-U’s to start RRT and now we know “Y”! The Start-AKI Trial
So the below is only my opinion! We are definitely in an evidence free zone and this is not meant to guide management! However this is my nightmare. A 53 yo ESRD is BIB EMS to a small community hospital. Her chief complaint: missed dialysis. She reports staying at her NH and not having been […]
Read More Case Report: IV access in a dialysis patient: An Evidence free zone!
HYPONATREMIA PART I – TREATMENT RECOMMENDATIONS IN CASE OF HEMODYNAMIC INSTABILITY, THE NEED FOR RAPID FLUID RESUSCITATION OVERRIDES THE RISK OF AN OVERLY RAPID INCREASE IN SERUM SODIUM CONCENTRATION. TREATMENT GOALS: An increase by 4-6-mmol/L [Na] is sufficient to reverse most serious manifestations of acute hyponatremia. Increase [Na] no more than 10 mEq/L in 24 hour […]
Read More HYPONATREMIA 2.0
As we all know hyperkalemia is a life threatening condition. But how can something so basic be shrouded in such confusion? So many choices and everyone has their own recipe to fix it. Along with all the treatment choices, come pitfalls and side effects. Thus, we need to know what is the best way to […]
Read More Hyper K, The EBM Way: Protect, Push, and Purge
One of the most physiologically complicated yet overly simplified “set it and forget it” protocols in emergency medicine just might be the acute treatment of hyperkalemia. We all have the protocol in our head and can write it up in our sleep (hopefully) but how effective is it? How safe is it? How evidenced based […]
Read More Quick Hit Article #6: How much insulin to give ESRD patients with Hyper K?
A blood gas interpretation is often a fear inducing “pimp” question. Probably because there is a so much packed into them and at some point, some basic math is needed. So, let’s try to unpack it a little so we have more method and less madness. I’m going to divide this up into 4 parts: […]
Read More The ABC’s of ABG’s or How to read a blood gas without the Hassel(bach)