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Admission from emergency room ( er )

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Admission from emergency room ( er )

  1. 1. Ministry of Health Dakahlia Medical diroctorate New Mansoura General Hospital Nephrology Department Dr. Osama El Shahat Consultant of Nephrology Dr. Wael Ramadan Head of nephrology department New Mansoura General Hospital Resident of nephrology New Mansoura General Hospital Protocol Of Admission From emergency room ( ER )
  2. 2. A)EMERGENCY ROOM WORK UP: These items have to be fulfilled by nephrologists responsible for ER:- 1-full history of the patient with focusing on the complaint. 2-vital signs: blood pressure, pulse, temperature and respiratory rate. 3-abdominal ultrasound. 4-CBC,s.creatinine ,blood urea ,s.K ,s.Na ,ABG and INR. 5-Chest x-ray is mandatory in case of dyspnea. 6-ECG if arrhythmia or IHD is suspected to be the cause of dyspnea or chest pain. 7-Start life saving measures as needed in ER (e.g antihyperkalemic measures ). 8-referal to other specialities. 9-Complete the admission file by the same responsible nephrologist in ER. B)CASES TO BE ADMITTED TO NEPHROLOGY DEPARTMENT: 1-Emergency Hdx: a)when Hdx is life saving : pulmonary oedema ,severe metabolic acidosis(caused by renal failure),hyperkalemia and ureamic coma. b)severe ureamic manifestations(e.g pericardial or pleural effusion, recurrent vomiting, etc.) requiring start of regular Hdx. c) severe volume overload. d)central cath insertion for access failure in Hdx patients. e)please overview protocol of Hdx.
  3. 3. 2-AKI patients: a)R,I and F stages of AKI according to RIFLE criteria should be admitted. b)Exceptions include postrenal causes ,hepatorenal syndrome ,cardiorenal syndrome and heamodynamically unstable patients. c)Aim of admission is restoring water and electrolyte hemostasis ,correction of the cause and follow up to assess need for Hdx. d)cases with raised s. creatinine that is not evident to be acute should be referred to nephrology clinic unless in need for emergency Hdx RIFLE criteria S. creatinine Urine output RISK S.cr > 1.5 x baseline UOP < 0.5ml/kg/h x 6h. INJURY S.cr > 2 x baseline UOP < 0.5ml/kg/h x 12h. FAILURE S.cr >than 3 x baseline Or S.cr > 4mg/dl UOP < 0.3ml/kg/h x 24h Or anuria x 12h. LOSS Complete loss of function > 4 weeks ESRD ESRD > 3 months

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