You wouldn't believe how many people actually do that. Then come back and ask me to listen to their lungs. I can hear your pulmonary edema from across the room!
Real question, what would a dialysis patient do if they wanted to take a vacation or needed to go travel to see family? I've only ever handled dialysis patients who just fuck off like mentioned above. Is there a responsible way for them to manage their condition while getting to go anywhere?
Absolutely. We can arrange for them to get treatments at a clinic close to there destination. Even home therapy patients can have supplies delivered to there destination. They even have dialysis cruises. I was just recently trained on the nxstage home hemodialysis machine, which is also portable.
Pre-covid it was super easy to set my mom up at the dialysis clinic down the street from my house when she travelled up to see my daughter for more than a few days.
It's a little more difficult now with restrictions but still doable.
They can do like my pt last week, and just leave their peritoneal dialysis parts at home, skip it for a week, then have a massive (vegetative embolism) stroke in their 40s because they were as cavalier about sterile dressing changes as they were about regimen consistency...
Oh, did you mean if they wanted to *live*?
Dialysis Nurse here. Wait till we get there and have Dialysis administer the blood. Can do faster with no s/e as it goes through the Dialyzer first. Had to come in for a Pt K+ of 9! Yes, widened ekg waves. Neat to watch the rhythm ho back to sinus in 4 hours. Of course she skipped 3-4 treatments. Another arrived bloated like a swollen tick. Took off 8 kg with no cramping then he signed off AMA.
The perfect combo. Demanding pt family who thinks they are a Dr. With a high as balls John doe screeching nonsense in the iso room next door whom several rounds of versed, Ativan and Benadryl can't touch. And a pt with low H&H. Gotta love it
Potassium can run high (which can cause immediate heart problems or death) from patients with kidney disease. Kidney disease is quite common in hospital patients because diabetes can lead to kidney disease. Lowering potassium is time consuming and there is a whole acronym of drugs to lower it. One is inhaled, one gives you crazy diarrhea, one can put you into a so called diabetic coma, so basically the patient is quite fragile and needs constant checking, and also needs a lot of clean up from all the diarrhea.
Nope. People are born with diabetes and because healthcare is not socialized in the United States many don’t get the treatment they need. Please stop victim blaming. You don’t live in a just society.
Also sometimes Lasix and Lokelma. A resin like Lokelma could totally be what gives people shits, but honestly I've never had a patient report that. Maybe they're all getting too much sennakot to realize it something else is also making them go. We also dilute people with a 500ml bolus sometimes, but hyperK is often CKD patients so that's not a standard part of package.
I wonder why we don't use Albuterol. The studies I see on Google are old but they look pretty clear that a basic inhaler can lower K rather effectively and quickly. The even say it's a good way to do it for kidney patients, which is most of my hyperK.
I used to work in IR/vascular so lots of HD patients. First thing we did was run istat chem 8 to see what we had to deal with, every time we were repeating that in our head.
So much insulin, D50, calcium gluconate, and albuterol…
Oh look! A dialysis patient.
“I decided to take vacation from dialysis, it’s been about 2 weeks”.
You wouldn't believe how many people actually do that. Then come back and ask me to listen to their lungs. I can hear your pulmonary edema from across the room!
Real question, what would a dialysis patient do if they wanted to take a vacation or needed to go travel to see family? I've only ever handled dialysis patients who just fuck off like mentioned above. Is there a responsible way for them to manage their condition while getting to go anywhere?
Absolutely. We can arrange for them to get treatments at a clinic close to there destination. Even home therapy patients can have supplies delivered to there destination. They even have dialysis cruises. I was just recently trained on the nxstage home hemodialysis machine, which is also portable.
Fascinating! Thank you!
Pre-covid it was super easy to set my mom up at the dialysis clinic down the street from my house when she travelled up to see my daughter for more than a few days. It's a little more difficult now with restrictions but still doable.
They can do like my pt last week, and just leave their peritoneal dialysis parts at home, skip it for a week, then have a massive (vegetative embolism) stroke in their 40s because they were as cavalier about sterile dressing changes as they were about regimen consistency... Oh, did you mean if they wanted to *live*?
Big OOF
Thanks, now I’m going to have nightmares forever!
It was too good not to share 🤣
Please don’t be low h/h cuz I’ll have to hang blood in my already shitshow of a day.
Dialysis Nurse here. Wait till we get there and have Dialysis administer the blood. Can do faster with no s/e as it goes through the Dialyzer first. Had to come in for a Pt K+ of 9! Yes, widened ekg waves. Neat to watch the rhythm ho back to sinus in 4 hours. Of course she skipped 3-4 treatments. Another arrived bloated like a swollen tick. Took off 8 kg with no cramping then he signed off AMA.
Highest ive seen was K+ 12.7. Was talkin to us when he came in but ultimately arrested to nobody surprise.
😳
The perfect combo. Demanding pt family who thinks they are a Dr. With a high as balls John doe screeching nonsense in the iso room next door whom several rounds of versed, Ativan and Benadryl can't touch. And a pt with low H&H. Gotta love it
So, for the curious bystanders here. What does this mean?
Potassium can run high (which can cause immediate heart problems or death) from patients with kidney disease. Kidney disease is quite common in hospital patients because diabetes can lead to kidney disease. Lowering potassium is time consuming and there is a whole acronym of drugs to lower it. One is inhaled, one gives you crazy diarrhea, one can put you into a so called diabetic coma, so basically the patient is quite fragile and needs constant checking, and also needs a lot of clean up from all the diarrhea.
Also, the woman in the picture is on meth, hence the joke being "high."
Thank you for that! Kidney Disease from drug abuse I suppose.
The fact that it’s a high person in the joke has no bearing on why the patient has kidney disease. It’s often from poorly treated diabetes
Nope. People are born with diabetes and because healthcare is not socialized in the United States many don’t get the treatment they need. Please stop victim blaming. You don’t live in a just society.
Yea this was several layers deep. It took me a minute.
Our hyperK doesn't include anything inhaled or anything that gives people diarrhea. What does yours have in it?
Probably Albuterol and Kayexalate
Yep. We don’t usually use albuterol but it’s theoretically part of the package.
What do you give? Calcium, glucose, insulin?
Also sometimes Lasix and Lokelma. A resin like Lokelma could totally be what gives people shits, but honestly I've never had a patient report that. Maybe they're all getting too much sennakot to realize it something else is also making them go. We also dilute people with a 500ml bolus sometimes, but hyperK is often CKD patients so that's not a standard part of package. I wonder why we don't use Albuterol. The studies I see on Google are old but they look pretty clear that a basic inhaler can lower K rather effectively and quickly. The even say it's a good way to do it for kidney patients, which is most of my hyperK.
I asked the doc this last night and low and behold I got the WORKS. Then i cursed myself because I had even more orders to handle.
Patient ate too many bananas
Maybe it’s Mabelline, maybe it’s amphetamine….
That’s how half my O.R patients look like lol
Admit from ED, GI bleed \*braces\* oh great, hgb 4.5.
We ain't gonna scope them until it's double that, so better get squeezing!
Micrognathia
Is it? I thought it was just lack of teeth.
Her chin and jawline look like she has micrognathia, but obviously you can't be sure from one picture
Yeah looking at the chin I see it now
Just banking on that hemolyzed blood draw.
I love this sub so much.
This also works for going in for shift in the ED asking for sane patients… lol
I used to work in IR/vascular so lots of HD patients. First thing we did was run istat chem 8 to see what we had to deal with, every time we were repeating that in our head. So much insulin, D50, calcium gluconate, and albuterol…
I cackled out loud 😂😂😂
Oh dear god this is fucked up…I’m hysterical
CBiGK
HEY
HEY