TRANSITION SERIES Topics for the Advanced EMT CHAPTER Renal Disorders 32

Objectives Discuss the frequency rates for renal diseases in the U.S. Review basic renal physiology. Discuss pathophysiology of renal- related disorders. Review basic assessment and management strategies.

Introduction Renal disorders are those that pertain to the kidneys. Potentially painful or fatal pathophysiologic changes can occur with renal diseases.

Epidemiology Renal diseases affect about 20 million people in the United States. 350,000 Americans receive dialysis for end-stage renal disease. 50,000 people die each year from kidney disease.

Pathophysiology Kidneys –Production and elimination of urine –Maintain electrolyte balance –Contribute to the body's pH

Pathophysiology (cont’d) Kidneys (continued) –Can be damaged by traumatic or nontraumatic etiologies.  Inflammation  Infection  Obstruction  Hemorrhage

Pathophysiology (cont’d) Renal conditions –Kidney stones –Kidney failure –Dialysis-related emergencies

Pathophysiology (cont’d) Renal conditions – kidney stones –Crystals that form in the kidneys that may obstruct urine flow or get trapped in the ureters or urethra

Sectioned kidney with kidney stones. (© SIU/Photo Researchers, Inc.)

Pathophysiology (cont’d) Renal conditions – renal failure –Acute renal failure  Occurs over a period of days  Can result in serious metabolic derangements –Chronic renal failure  Occurs over a period of years  Permanent loss of nephrons  Waste products will accumulate

Pathophysiology (cont’d) Renal conditions – dialysis –Artificial process used to remove water and waste from the body due to CRF or ARF –Two types  Hemodialysis  Peritoneal dialysis

Assessment Findings General assessment considerations –Dialysis patients are often on heparin; falls can result in serious bleeding. –Ask patient about use of dialysis. –Ask about changes to urine. –Ask about shunt or graft placements. –Ask about other medical problems.

Assessment Findings (cont’d) General assessment findings –Abnormal urination (odor, color) –Abdominal or flank pain –Fever, malaise, nausea, vomiting –Pain or burning during sex –Increased urge to urinate –Hematuria, oliguria –Anorexia, tachycardia

Assessment Considerations Do not obtain a blood pressure in an arm with a dialysis shunt or fistula. Do not establish intravenous access in an arm with a dialysis shunt or fistula. Palpation of the abdomen commonly elicits pain.

Patients who experience a renal emergency may complain of abdominal, flank, or lower back pain, or tenderness on palpation.

Emergency Medical Care Ensure airway adequacy. Provide oxygen based on need. –Apply oxygen to keep SpO 2 >95%. –NRB or PPV based on breathing adequacy. Control external hemorrhage if present.

Emergency Medical Care (cont’d) Place patient in position of comfort. Calm and reassure the patient. Initiate transport. If you choose to initiate intravenous access, do so en route to the hospital. Continuously monitor and reassess.

Case Study You are dispatched to a local construction site for someone with abdominal pain. Upon your arrival, you are directed to a big burly man who is sitting on a chair, all hunched over. As you approach he stands up and starts walking, but then sits down again. He looks at you and says, “Help me man, I can‘t get comfortable – my belly is on fire!”

Case Study (cont’d) Scene Size-Up –Scene is safe. –Standard precautions taken. –Patient is 32 years old, male, 240 lbs. –Entry and egress from site is unobstructed. –NOI appears to be back pain. –No additional resources needed.

Case Study (cont’d) Primary Assessment Findings –Patient alert and well oriented. –Airway patent. –Breathing normally, talks in full sentences. –Peripheral perfusion intact. –Primary complaint is for severe abdominal pain.

Case Study (cont’d) What kind of differentials could you consider at this time? What care should be provided at this time?

Case Study (cont’d) Medical History –Patient has no medical history. –Stated he was “going to pee” when the pain started in his back. Medications –None Allergies –None

Case Study (cont’d) Pertinent Secondary Assessment Findings –Pupils equal and reactive, membranes moist. –Airway patent and breathing normal but fast.

Case Study (cont’d) Pertinent Secondary Assessment Findings –Perfusion intact and strong, pulse fast. –No history of trauma or similar incident. –Back pain happened suddenly, rated as “10.”

Case Study (cont’d) Pertinent Secondary Assessment Findings (continued) –States pain has traveled to his groin; he also tells you he “peed blood twice today.” –PMS present times 4, SpO 2 98% on room air. –BGL normal, no other contributory findings.

Case Study (cont’d) What may be the cause of the back pain? What other dangerous process could be going on here? What would be three assessment findings that could confirm your suspicion?

Case Study (cont’d) Care provided: –Patient placed on low-flow oxygen. –Placed in the most comfortable position attainable on wheeled cot. –Transport initiated to ED. –Established intravenous access.