Hematologic & Renal Emergencies Flashcards
Blood represents it’s own organ system..What are the functions?
– Clotting
– Delivery of oxygen and removal of CO2
– Removal and delivery of waste products to organs that remove them
What is Blood Made Of?
• Made up of solid components – Red blood cells – White blood cells – Platelets – Plasma • Medications can affect some components of blood
Anemia
• Lower-than-normal amount of red blood cells • Acute anemia – Sudden blood loss • Chronic – Excessive menstrual periods – Slow gastrointestinal bleeding – Diseases affecting bone marrow
Sickle Cell Anemia
• Genetic disease affecting RBCs • More prevalent in certain ethnicities – African Americans – Indian or Middle Eastern descent • Defective shape resembles a sickle • Cells have a short life span leading to anemia
Complications of Sickle Cell Anemia
- Destruction of spleen
- Sickle pain crisis
- Acute chest syndrome
- Priapism
- Stroke
Treatment of Sickle Cell Anemia
- High flow supplemental oxygen
- Monitor for respiratory distress
- Monitor for signs of hypoperfusion
- Transport to stroke center if stroke is suspected
Think About It: Sickle Cell Anemia
- One in twelve African Americans have the sickle cell trait.
- Sickle cell trait doesn’t always lead to complications.
- Possible to lead a normal life with sickle cell trait.
Renal System Components & Function
• Components – Two kidneys – Two ureters – One urethra • Responsible for filtering blood and removing waste • Maintains fluid balance • Maintains acid/base balance
Renal Failure
- Occurs when kidneys lose ability to adequately filter and remove toxins
- Acute failure typically results from shock or toxic ingestion
- Chronic failure may be inherited or secondary to damage from uncontrolled diabetes or hypertension
End-Stage Renal Disease (ESRD)
• Irreversible renal failure • Requires dialysis – Hemodialysis – Peritoneal dialysis • 90% receive hemodialysis in specialized centers
Think About It: Renal Disease
- More than 350,000 people in America receive some type of treatment for ESRD.
- Only 8% treat themselves at home.
- ESRD patients often rely on EMS for transport to and from dialysis.
Hemodialysis
- Patient connected to a machine that pumps blood through specialized membranes
- Treatments last several hours, multiple times a week
Hemodialysis
• Two types of access to blood circulation
– Two-port catheter
– A-V fistula
Peritoneal Dialysis
- Uses peritoneal cavity’s large surface area
- Special fluid infused into abdominal cavity and left for several hours to absorb waste and excess fluid
- Fluid is removed and discarded
Medical Emergencies in ESRD
• Two broad groups – Loss of kidney function – Complication of dialysis • Most dialysis patients have underlying medical factors – Diabetes – Hypertension
Complications of ESRD
• Usually relate to patient missing dialysis
• Present with signs and symptoms similar to congestive heart failure
– Shortness of breath
– Edema
– Electrolyte disturbances
Missed Dialysis
- Assess ABC’s
- Be aware of fistulas
- Administer oxygen
- Monitor vital signs closely and have AED ready
- Transport to facility capable of dialysis
Complications of Dialysis
• Bleeding from A-V fistula
• Clotting and loss of A-V fistula function
• Infection
– Peritonitis
Treatment of Dialysis Complications
• Assess ABC’s • Control bleeding – Contact medical control if necessary • Administer oxygen • Treat for shock – Keep patient supine and warm • If peritonitis is suspected, transport dialysis fluid for confirmation
Kidney Transplant Patients
• Kidneys are the most transplanted organs
– Approximately 16,000 transplants per year
• Patients spend their lives on specialized medications
– Help prevent organ rejection
– Increased susceptibility to infections
Chapter Review: Hematologic & Renal Emergencies
- Does my patient have a history of sickle cell disease or ESRD?
- Does my patient have an A-V fistula?
- Will I need to make an early request for ALS because of complications from a missed dialysis appointment?
Critical Thinking: Hematologic & Renal Emergencies
• You have a patient who is transported routinely for dialysis three times per week.
She was sick and canceled the trip yesterday. Now she calls saying she can’t breathe and feels like she is going to die. Is it possible that she has a legitimate
complaint after missing dialysis by only one day?
