Conference Notes 1/15/2024

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  • Central Venous Access – Drs. Stults and Wells
    • Locations: IJ (R 15cm, L 18cm), Subclavian(R 14cn, L 17cm), Femoral
    • Procedure SIM
  • “To Pee or Not to Pee?” – Dr. Williams
    •  Rhabdomyolysis
      • Muscle breakdown – Meds, toxic ingestion, increased muscle activity
      • UA with positive heme/blood without RBCs
      • CK > 5000
      • Electrolyte abnormalities
      • McMahon Score
      • Treat by removing precipitating factors, Rehydrate as needed, treat electrolyte abnormalities, maybe dialysis
    • Acute Kidney Injury (AKI)
      • KIDGO Criteria
      • 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
      • Often with GFR <15L/min
      • 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
      • AKI
      • Diagnosis of exclusion (takes 2 days of albumin therapy to diagnose)
      • Treat with albumin
  • US Image Review – Drs Baker and DiMeo
    • Vitreous detachment
    • Retinal Detachment
    • Nerve Block
  • 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

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