Renal
A sudden loss of kidney function → kidneys cannot filter waste or regulate fluid/electrolytes.
Prerenal → decreased blood flow (dehydration, shock). Intrarenal → kidney damage (toxins, meds). Postrenal → obstruction (stones, enlarged prostate)
what is AKI?
Phases: Emergent (ABCs/fluids), Intermediate (healing/infection control), and Rehabilitative (contracture prevention).
Hypotension, Tachycardia, Decreased urine output, Edema
PRIORITY = airway; Fluids (Lactated Ringer’s)
Chronic liver damage → fibrosis (scar tissue) → liver cannot function properly.
This causes: Portal hypertension; Decreased protein production (albumin); Impaired detoxification
Liver function tests: AST/ALT ↑ , Bilirubin ↑ (jaundice) ; Albumin ↓ ; PT/INR ↑ (bleeding risk)
what is cirrhosis?
Inflammation of pancreas → digestive enzymes attack pancreas itself. Amylase ↑; Lipase ↑ (MOST specific)
CT scan. Severe abdominal pain (radiates to back)
NPO (REST pancreas)
IV fluids
Pain control
NG tube if needed
what is Pancreatitis?
Anything that increases volume in the skull (blood, swelling, tumor) → ↑ pressure → ↓ brain perfusion → brain injury. Mannitol (osmotic diuretic)
Normal: 5–15 mmHg
Change in LOC (MOST IMPORTANT)- early; late: cushing's triad
what is ICP?
Blood is removed, filtered through a machine, and returned.
Check access (AV fistula/graft): Thrill (vibration) ; Bruit (whooshing sound)
NO:BP, IV, blood draws on that arm
What is Hemodialysis?
2 mL (or 4 mL) x kg x %TBSA = 24-hr total. Give half in the first 8 hours.
what is the parkland formula?
Jaundice
Ascites
Peripheral edema
Confusion (hepatic encephalopathy)
Bruising/bleeding
Spider angiomas
Fatigue
what are manifestations of Cirrhosis?
Blockage prevents movement of intestinal contents. Adhesions (MOST COMMON). High-pitched bowel sounds (early).
NPO
NG tube (decompression)
IV fluids
Monitor electrolytes
what is a bowel obstruction?
Bleeding into subarachnoid space (often from aneurysm rupture). Sudden “worst headache of life”. Nimodipine (prevents vasospasm)
what is SUBARACHNOID HEMORRHAGE?
This life-threatening neurological complication can occur during or immediately after a patient's first dialysis session due to the rapid removal of urea from the blood, causing cerebral edema.
What is Dialysis Disequilibrium Syndrome (DDS)?
Head (9%), Arms (9% each), Legs (18% each), Trunk (36%), and Perineum (1%).
what is the rule of nines?
Lactulose → ↓ ammonia (causes diarrhea)
Rifaximin → reduces ammonia-producing bacteria
Diuretics (spironolactone, furosemide)
Vitamin K (bleeding)
Procedures: Paracentesis (remove ascitic fluid)
what are the treatment/medication options for cirrhosis?
Liver cannot detoxify ammonia → ammonia builds up → affects brain. Asterixis (flapping hands).
Lactulose → causes diarrhea → removes ammonia
Rifaximin → reduces ammonia production
If confused cirrhosis patient → give lactulose, not sedatives
what is Hepatic Encephalopathy?
Damage interrupts nerve signals → loss of movement and sensation below injury. Complete Injury – total loss of motor & sensory function below the level of injury. Incomplete Injury – incomplete structural damage with some function preserved below the level of injury
Cervical injuries (C1-C4): inability to breathe & tetraplegia; Cervical injuries (C5-C8): tetraplegia with various degrees of arm movement; Thoracic injuries: paraplegia with poor trunk control; Lumbar injuries: decreased control of legs; bowel & bladder dysfunction.
what is a SPINAL CORD INJURY?
Dialysis fluid is placed into abdomen → waste diffuses across peritoneal membrane.
Dialysate appearance: Clear = normal
Warm dialysate before administrating
what is Peritoneal Dialysis?
Can rapidly compromise airway, breathing, circulation, and brain perfusion. The goal is to identify and treat life-threatening problems immediately.
what is trauma?
Tube feeding directly into GI tract → risk for aspiration and GI intolerance.
X-ray to confirm placement (GOLD STANDARD)
Aspiration = priority complication
what is enteral feedings?
Too little ADH → kidneys cannot retain water → massive water loss. Desmopressin (DDAVP) → replaces ADH
Polyuria (VERY high output)
Polydipsia
Dry skin
Hypotension
Tachycardia
what is DI?
Severe hypertension; Headache; Flushed skin
Sit patient upright, Remove cause (full bladder, etc.); Monitor BP
what is Autonomic Dysreflexia (EMERGENCY)?
Inflammation/infection of peritoneum
Abdominal pain, Fever, Rigid abdomen, Nausea
Antibiotics: Stop dialysis temporarily
what is Peritonitis?
A – Airway (with cervical spine protection); B – Breathing, C-circulation, D – Disability (Neurologic), E – Exposure
Full history (AMPLE):Allergies, Medications, Past medical history, Last meal, Events leading to injury
Head-to-toe exam
what is primary and secondary survey?
Nutrition given IV (bypasses GI tract); Glucose monitoring (MOST IMPORTANT); Hyperglycemia, Infection (central line), Electrolyte imbalance
If it runs out→ hang D10 (prevent hypoglycemia)
What is TPN?
Too much ADH → water retained → dilution of sodium. Fluid restriction (MOST IMPORTANT). Seizure precautions.
Hypertonic saline (severe cases)
Diuretics
“Saves water”
what is SIADH?
Ischemic: clot blocks blood flow; Hemorrhagic: bleeding in brain. tPA (within 3–4.5 hrs for ischemic stroke)
Right Hemisphere- Altered perception of deficits. Unilateral neglect syndrome (ignore the left side of the body). Loss of depth perception. Poor impulse control and judgment. Left hemiplegia or hemiparesis. Visual changes, such as hemianopsia (loss of visual field in one or both eyes)
Left Hemisphere-Expressive and receptive aphasia. Agnosia (inability to recognize familiar objects). Alexia (reading difficulty). Agraphia (writing difficulty). Right extremity hemiplegia (paralysis) or hemiparesis (weakness). Slow, cautious behavior. Depression, anger, quick to become frustrated. Visual changes such as hemianopsia
what is a stroke?