The sickest patients, who receive world-class care in the trauma/critical care bay of University of Louisville Department of Emergency Medicine
![Room9er ["Room Niner"]:](https://room9er.com/wp-content/uploads/2020/03/cropped-Screen-Shot-2020-03-08-at-3.16.16-PM.png)
- Central Venous Access – Drs. Stults and Wells
- Locations: IJ (R 15cm, L 18cm), Subclavian(R 14cn, L 17cm), Femoral
- “To Pee or Not to Pee?” – Dr. Williams
- Rhabdomyolysis
- Muscle 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 Encephalopathy
- Cerebral 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 Syndrome
- Advanced 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. Kuzel
- Trial 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