The sickest patients, who receive world-class care in the trauma/critical care bay of University of Louisville Department of Emergency Medicine
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Central Venous Access – Drs. Stults and WellsLocations: IJ (R 15cm, L 18cm), Subclavian(R 14cn, L 17cm), Femoral
“To Pee or Not to Pee?” – Dr. Williams RhabdomyolysisMuscle breakdown – Meds, toxic ingestion, increased muscle activity UA with positive heme/blood without RBCs Electrolyte abnormalities Treat by removing precipitating factors, Rehydrate as needed, treat electrolyte abnormalities, maybe dialysis Acute Kidney Injury (AKI)Staging (stage 1-> stage 3) Pre-renal, Intra-renal, Post-renal Screening/Labs: Electrolytes, CMP, BMP, CK, UA, Renal US, FENa Uremic EncephalopathyCerebral dysfunction from accumulation of eremic toxins in acute or chronic renal failure Delirium, fatigue, anorexia, nausea, asterixis/myoclonus, seizures CMP/BMP. CBC, EEG, CT Head/MRI Brain Treated with dialysis (must evaluate for other causes of delirium)
Hepatorenal SyndromeAdvanced cirrhosis causes systemic dilation, to compensate for low BP and SVR body releases endogenous catecholamines and activates RAAS Diagnosis of exclusion (takes 2 days of albumin therapy to diagnose)
US Image Review – Drs Baker and DiMeo
Introduction to Observation Medicine (OLOU) – Dr. KuzelTrial of therapy, Continued Diagnostic work up, risk stratification, Optimization before discharge home, assessment of acute psychosocial needs Patient can be discharged within 24 hours Specific inclusion and exclusion criteria, protocol based NOT an ambiguity or continued decision unit NOT an additional annex for ED holding patients NOT for patients admitted to other services
Soft Launch of ULOU on Feb 3
Maximum number of 5 obs patients at a time
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