The EM Educator Series: The Sick ESRD Patient

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Case 1:

A 61-year-old male with history of ESRD presents with chest pain during his dialysis session. His session was stopped, and EMS was called. He is currently hemodynamically stable.

Case 2:

A 55-year-old female is brought in for altered mental status. She has a history of ESRD. On exam, she is hypotensive, with GCS 10.

Considerations:

• What neurologic complications can occur in patients with ESRD?
• What cardiopulmonary complications can occur in patients with ESRD?
• What infectious complications can occur in patients with ESRD?
• What should you consider in obtaining vascular access in patients with ESRD?
• What are complications with dialysis fistulas?
• What are considerations in treatment of hyperkalemia in this population?
• How can labs be affected by ESRD? How about troponin?
• What medication considerations are recommended in these patients?

Suggested Resources:

• Articles:
  • emDocs Cases – Sick ESRD Patient
  • emDocs – Management of the Sick Dialysis Patient
  • REBEL EM – ECG changes with hyperkalemia
  • emDocs – Troponin in ESRD and CKD
  • emDocs – Sepsis Comorbidities Management Strategies
  • emDocs – Managing Fistula Complications
  • emDocs Cases – Updates in Management of Hyperkalemia

• PMID:
  • American Journal of Emergency Medicine