This week we discuss some of the many dialysis-related emergencies we frequently see in the ED.
Core EM - Emergency Medicine Podcast Episode 92.0 – Dialysis Emegencies
Apr 10, 2017
This discussion dives into urgent dialysis-related emergencies encountered in the ED. It highlights the critical assessment of dialysis access sites, emphasizing detection of complications. Bleeding management techniques for dialysis fistulas are shared, along with essential strategies for addressing bacterial peritonitis in patients. The conversation also sheds light on dialysis disequilibrium syndrome, detailing its symptoms and initial treatment approaches. Overall, it's a must-listen for emergency professionals tackling these complex cases.
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Transcript
Episode notes
Assess Dialysis Access Thoroughly
- Always thoroughly assess dialysis access sites on exam. - Check fistulas for thrill, warmth, erythema, sensation, and perfusion; check catheters for infection signs.
Fistula Bleeding Emergency Story
- A patient bleeding from his fistula outside the hospital created a dramatic blood trail inside. - The case exemplifies how aggressively fistulas can bleed and the urgency needed to control it.
Control Fistula Bleeding Stepwise
- Start fistula bleeding control with direct pressure held by a single or two fingers. - If that fails, use topical thrombotic agents and, as last resort, a figure-eight stitch with 5-0 proline.