Presentation on theme: "Genitourinary and Renal Emergencies"— Presentation transcript:
1Genitourinary and Renal Emergencies Chapter 21Genitourinary and Renal Emergencies
2National EMS Education Standard Competencies MedicineIntegrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint.
3National EMS Education Standard Competencies Genitourinary/RenalBlood pressure assessment in hemodialysis patientsAnatomy, physiology, pathophysiology, assessment, and management ofComplications related to:Renal dialysisUrinary catheter management (not insertion)Kidney stones
13Kidneys Glomerular capsule Podocytes Double-layered cupPodocytesForm filtration slitsBlood moves from the afferent arteriole into the capillaries of the glomerulus.Pressure increases.
14KidneysThe filtrate initially contains everything that can pass through the filtration membrane.As filtrate passes through the rest of the nephron, it is converted to urine.Additional reabsorption of water and electrolytes occurs in the loop of Henle.
15Kidneys After leaving the loop of Henle, the fluid enters the DCT. The juxtaglomerular apparatus is formed where the efferent arteriole meets the DCT.ADH and aldosterone control the final adjustments to the composition of urine.
16KidneysNeurons in the hypothalamus monitor the solute concentration of the blood.Aldosterone plays an active role in reabsorption.Diuretics increase urinary output.Work in a variety of ways
17Ureters Urine: Enters the collecting ducts Passes through the calyces Goes to the renal pelvisMoves through the ureters
18Urinary Bladder Collapses when empty Expands when full The brain controls the urge to void.External urinary sphincter remains contracted until conditions are favorable
19Urethra Part of the lower urinary tract Expels urine Male urethra is divided into three regions.
20Scene Size-Up Take standard precautions to avoid contact with urine. Renal problems may mimic other abdominal problems.It may be difficult to identify the source of pain.
21Primary Assessment Form a general impression Airway and breathing Patient may exhibit extremes of activityAirway and breathingCirculationTransport decisionConsider how the patient will be moved.
22History Taking History and physical exam Provide the necessary information for patient managementEighty percent of all medical diagnoses are based on the patient's history.
24ReassessmentElectrolyte imbalances can cause rapid deterioration in the functioning of organs.Form a treatment plan.Take serial vital signs at least every 5 minutes in patients with possible renal failure.
25Pathophysiology, Assessment, and Management of Specific Emergencies Range from mild to true emergenciesPrehospital care is usually supportive.Recognizing the condition helps provide a positive outcome.Many of these conditions cause urinary retention.
26Pain Pathophysiology Assessment Pain may be: VisceralReferredAssessmentUse OPQRST to evaluate type and severity
27PainManagementAfter assessing ABCs, allow patient to assume a position of comfort.Be prepared for potential nausea and vomiting.Provide analgesia if necessary.Establish an IV line.
28Urinary Tract Infections (UTIs) Definitive treatment requires antibiotics.PathophysiologyUsually develop in lower urinary tractSpread if untreated
29Urinary Tract Infections (UTIs) Classic symptoms:Painful urinationFrequent urges to urinateDifficulty urinatingPainPatients appear restless and uncomfortable.Vital signs vary based on degree of illness.
30Urinary Tract Infections (UTIs) ManagementMainly supportive care of ABCsTransport in a position of comfortBe prepared for nausea or vomiting.Analgesics in severe cases onlyEstablish an IV line.
31Urinary CathetersMany patients hospitalized for a urinary problem or disease receive catheterization.Urine backflow is a concern when transporting a catheterized patient.Do not lift the drainage bag while handling the patient.
32Urinary Incontinence Loss of bladder control Medical problem if in one of two categories:Urge incontinenceOverflow incontinence
34Renal Calculi (Kidney Stones) Pathophysiology (cont’d)Calcium stonesMost commonMay have a hereditary componentStruvite stonesMore common in womenUric acid and cystine stonesLeast common
35Renal Calculi (Kidney Stones) Assessment findingsPatients almost always experience pain.Patient may be restless or guard abdomenPalpation may be difficult.Vital signs vary.
36Renal Calculi (Kidney Stones) ManagementEnsure ABCs.Position of comfortAdminister analgesia if local protocols allow.Establish an IV line and administer fluids.
37Acute Renal Failure (ARF) Sudden decrease in filtration through the glomeruliCauses toxins to accumulate in the bloodTwo to seven percent of hospitalizations in the United StatesMortality rate of 50–80% in critical cases
38Acute Renal Failure (ARF) OliguriaUrine output of less than 500 mL/dayAnuriaComplete cessation of urine productionPatient may experience:Generalized edemaAcid buildupHigh levels of nitrogenousHigh levels of metabolic wastes in the blood
39Acute Renal Failure (ARF) If untreated, can lead to:Heart failureHypertensionMetabolic acidosisClassified into three typesBased on where it occurs
40Acute Renal Failure (ARF) PathophysiologyToxic buildup of nitrogenous wastes/salts in the blood causes problems including:Impaired mentationHypotensionFluid retentionTachycardia
41Acute Renal Failure (ARF) Pathophysiology (cont’d)Prerenal ARFCaused by hypoperfusion of the kidneysIntrarenal acute renal failure (IARF)Involves damage to 1 of 3 areas of the kidneyPostrenal ARFCaused by blockage of urine flow from kidneys
42Acute Renal Failure (ARF) Findings may include:TinnitusAnorexiaHypertensionAltered mental statusProlonged bleedingFlank painLook for any scars, ecchymosis, or distention on the abdomen.Palpate for pulsing masses.If available, a hematocrit and urinalysis may be helpful.
43Acute Renal Failure (ARF) ManagementMetabolic changes caused by ARF are life threatening.Support the ABCs.Place in shock position.Many ARF patients have comorbid diseases.
44Chronic Renal Failure (CRF) PathophysiologyInadequate kidney function caused by the permanent loss of nephronsScarring occurs as the damaged nephrons cease to function.Uremia and azotemia develop.Systematic complications develop.
45Chronic Renal Failure (CRF) Assessment findingsPatients present with:An altered level of consciousnessHypotensionTachycardiaOther signs and symptoms vary.Pericarditis and pulmonary edema are common.
46Chronic Renal Failure (CRF) ManagementSimilar to patients with ARFPatients will ultimately require renal dialysis.Due to electrolyte imbalances, be conservative with treatment plans.Transport in a calm manner.
47End-Stage Renal Disease (ESRD) PathophysiologyResult of untreated acute or chronic renal failureKidneys have lost all ability to functionFatal unless treated by dialysis or renal transplant
48End-Stage Renal Disease (ESRD) Initial signs and symptoms:ConfusionShortness of breathPeripheral edemaBruisingChest painBone painSigns and symptoms of advanced ESRD include:PruritusMuscle twitchingHallucinationsHypotensionIn the late stages, seizures/coma are possible.
49End-Stage Renal Disease (ESRD) ManagementTreatment is limited to renal dialysis or kidney transplant.Provide supportive care.Place the patient in the shock position.
51Renal DialysisMost patients undergoing chronic hemodialysis have some sort of shunt.
52Renal DialysisYou will usually only encounter dialysis machines when transporting patients to and from dialysis centers.Patients requiring dialysis usually undergo the process every 2 or 3 days for 3 to 5 hours.
53Renal DialysisPatients who miss dialysis treatments often present with signs of electrolyte imbalance.Other complications of dialysis include:Muscle crampsNausea and vomitingInfections at the IV site
55Male Genital Tract Conditions EpididymitisInfection that causes inflammation of epididymis along the posterior border of testisOrchitisWhen one or both testes become infectedPrehospital management is supportive.
56Male Genital Tract Conditions Fournier gangreneCauses infection and necrosis of the subcutaneal tissue and muscle in the scrotumThe scrotum will be spongy.Tissues will be gray-black.Prompt transport is required.Assess and treat for shock.
57Male Genital Tract Conditions PriapismA painful, tender, persistent erectionMaintain the patient’s privacy.Do not make assumptions about the cause.Treat the patient with respect.Ensure immobilization if you suspect spinal cord injury.
58Male Genital Tract Conditions PhimosisInability to retract the distal foreskin over the glans penisApply cold compress.Transport.ParaphimosisForeskin is retracted over the glans penis, is entrappedTrue emergencyCan result in necrosis of the glans
59Male Genital Tract Conditions Benign prostate hypertrophy (BPH)Age-related nonmalignant enlargement of the prostate glandMay be asymptomatic, or may lead to:Difficulty starting urine flowIncomplete emptying of the bladderIncreased urination at night
60Male Genital Tract Conditions Testicular massesRarely require prehospital treatmentMay present with or without painMost are benign cystic masses or a varicocele.Testicular cancer usually presents as a painless solid lump.
61Male Genital Tract Conditions Testicular torsionTwisting of the testicle on the spermatic cordMedical emergency if twisting reduces blood flow to testisUsually unilateralTransport carefully and promptly.
62Summary Chronic kidney disease is the most common renal disorder. The genitourinary system includes kidneys, its structures, urinary bladder, ureters, urethra, and reproductive organs.Blood flows through the kidney into the afferent arteriole, then through the glomerulus, then the efferent arteriole, and finally the peritubular capillaries where it is reabsorbed.
63Summary Urine forms in the nephrons. In the glomerular capsule, filtrate from the blood is converted into urine and is further concentrated.In the distal convoluted tubule, the composition of urine is further refined based on the body’s needs. Antidiuretic hormone and aldosterone are involved in adjusting the urine.
64Summary The juxtaglomerular apparatus releases renin. Diuretics are chemicals that increase urinary output.As urine collects in the bladder, the micturition reflex causes the bladder to contract, stimulating the urge to void.The female urethra is shorter than the male urethra and more prone to UTIs.
65SummaryDuring the physical exam, use the four-quadrant system and abdominal region mapping, perform cardiac monitoring, and do not give anything orally.Visceral pain and referred pain are two types of pain.Use OPQRST during assessments.Manage pain with positioning, analgesics and fluids as indicated, and supportive care.
66SummarySymptoms of a UTI include painful urination, frequent urination, difficulty urinating, and foul-smelling, cloudy urine. Management is mainly supportive care of the ABCs, keeping the patient in a position of comfort, administering IV fluid, and possibly administering analgesics.Catheterization of the bladder allows continuous outflow of urine and is a means to measure urine output. Avoid backflow.
67SummaryKidney stones result when an excess of insoluble salts or uric acid has crystallized in the urine. Symptoms include severe flank pain that may migrate to the groin.ARF results in a release of toxins into the blood. The three types are prerenal, intrarenal, and postrenal. Signs and symptoms range from hypotension and tachycardia to hematuria and peripheral edema.
68SummaryCRF is progressive and irreversible inadequate kidney function that leads to a buildup of wastes and fluid in the blood.Patients with ARF or CRF require support of the ABCs, administration of medications, calm transport, and psychological support.Acute or chronic renal failure can progress to end-stage renal disease.
69SummaryRenal dialysis removes toxic wastes and excess fluids from the blood, usually through a shunt, which connects the patient to the dialysis machine.Dialysis patients must be monitored.Leaking shunts should be tightened. If it has become disconnected at the vein, clamp the cannula and disconnect the patient from the machine.
70SummaryEpididymitis, Fournier gangrene, priapism, phimosis, benign prostate hypertrophy, testicular masses, and testicular torsion are specific conditions to the male genital tract. Prehospital management for most of these conditions is supportive. Consider administering analgesics; transport gently.