Nephrolithiasis – Dr. Concepcion

• Good overview of definition, etiology, clinical presentation, diagnosis, and management of kidney stones.
• Discussed options for imaging including US and role of non-contrast vs. contrast CT scans.
• Most stones pass spontaneously, but prompt recognition of obstruction with infection is critical because delayed decompression can lead to sepsis and permanent renal injury.

Fournier’s Gangrene – Dr. Coleman

• Time is tissue! Fournier’s gangrene is a surgical emergency – recognize it early, start broad-spectrum antibiotics, and obtain immediate surgical consultation.
• Diagnosis is primarily clinical – do not delay treatment for imaging if suspicion is high.
• Usually polymicrobial infection (aerobic and anaerobic bacteria)
• Discussed role of clindamycin/linezolid in toxin production inhibition

Urologic Devices – Dr. Shaw

• Reviewed case of patient who presented with AMS, electrolyte abnormalities, AKI and infection from post-operative foley catheter placement.
• Reviewed EKG findings of hyperkalemia and hyperkalemia protocol – Calcium, Insulin + Dextrose, IVF, Beta-2 agonist
• Great review and “show and tell” of multiple urologic devices:
  • Foley catheter: discussed types, indications (acute urinary retention >300cc PVR, gross hematuria with clots, GU trauma, critical illness/strict I/O), use and troubleshooting
  • Suprapubic catheter: discussed indications (GU trauma, inability to pass standard foley in setting of retention), placement and exchange (<6 weeks, call urology, >6 weeks, replace)
  • Ureteral Stents: discussed indications (malignancy, nephrolithiasis, stricture), expected complications (irritative bladder, flank pain, hematuria), abnormal complications (sepsis, stent obstruction, migration or fragmentation, and fistulation)
  • Nephrostomy Tubes: discussed indications (ureteral trauma, complete ureteral obstruction, prolonged urine drainage), complications (accidental removal, anuria, sepsis, gross hematuria and fistulation)
• Bonus review! Supraglottic Airway Devices, indications, and insertion/use
  • Discussed Failure To Ventilate algorithm (jaw thrust + suctioning  nasal trumpet  BVM  oral airway  EGD or I-gel)
  • Reviewed nasopharyngeal airways, bag-valve mask, oropharyngeal airways, supraglottic/extraglottic devices (I-gel, LMA, etc.)

STIs – Dr. Price

• Image review game
  • Takeaway: clinically, many STIs look very similar and do not always present classically; important to recognize and send off testing.
• Discussed multiple GU emergencies that may present, specifically with acute urinary retention.

Sepsis Updates – Marianne Dorsey, RN

• Reviewed Sepsis Continuum
• RN can initiate TIO Sepsis Alert for 2 or more SIRS, suspected or confirmed infection, with or without organ dysfunction  Sepsis Alert paged overhead  RN to notify MD
• Sepsis Time Zero – earliest time that patient meets criteria OR time documented by MD
• Reviewed 3 hour and 6 hour sepsis bundles including Tissue Perfusion Reassessment
• Reviewed Sepsis PowerPlans (Med Sepsis_ULH)
• Document reason for withholding or not giving full 30 mL/kg IVF and excluding criteria for not ordering sepsis bundle

Medical Director Update – Dr. Ross

• Discussed new NES study on BP goals in hemorrhagic strokes
• Discussed a case on hyperkalemia and reviewed the hyperkalemia order set
• Discussed goals for stroke patients including stroke team pre-notification if concern for LVO PTA and TNK feedback
• No more fast-gut sutures, plan to use vicryl rapide instead
• Alert charge nurse about any concern for Decon – pesticides, acids/bases, toxic industrial materials, gasoline
• Discussed ongoing FLUID-TBI Study