RENAL &

HEMATOLOGY

EMERGENCIES

JEFF SIMONS B.S. F-PC

GOALS

• Overview of renal system anatomy / physiology

• Discuss common medical / trauma renal issues

• Identify associated assessment keys

GOALS

• Introduction to hematology

• Discuss common blood disorders and their treatments

• Blood transfusion collection / administration

• Discuss basic lab values

ASSESSMENT

Systematic approach

• Appearance

• Auscultation

• Palpation

Obtaining a full history

• Surgeries

• Recent changes

• Description of pain

• Secondary symptoms

(Pearson, 2012)

RENAL SYSTEM

Kidney Locations

• Retroperitoneal space

• Surrounds great vessels

Function

• Filtration

• Waste elimination

• Electrolyte balance

CROSS SECTION

ENHANCE…

ENHANCE… ENHANCE…

ENHANCE… ENHANCE… ENHANCE…

RENAL FAILURE

• Types of renal failure

• Acute

• Chronic

ACUTE RENAL FAILURE

Three categories

• Prerenal

• Intrarenal

• Postrenal

PRERENAL ACUTE FAILURE

Causes

• Hypoperfusion of the kidneys

Assessment Keys

• Dizziness

• Hypotension

• Tachycardia

• Thirst

Treatment

• Treat underlying causes

• Restore blood flow

INTRARENAL ACUTE FAILURE

Internal damage to kidney

• Golmeruli capillaries

• Kidney tubules

• Renal parenchyma

Causes

• Immune mediated disease

• Toxins

• Inerstitial nephritis

INTRARENAL ACUTE FAILURE

Signs and Symptoms

• Flank pain

• Joint pain

• Hypertension

• Headache

• Confusion

• Seizures

• Oliguria

INTRARENAL ACUTE FAILURE

Treatment

• Removal of toxins

• Balance of electrolytes

• Fluids

POSTRENAL ACUTE FAILURE

Obstruction of urine outflow

• Blockage of urethra

• Shutdown of nephrons

POSTRENAL ACUTE FAILURE

Signs and symptoms

• Pain

• Groin

• Lower Flank

• Genitalia

• Oliguria

• Bladder distention

• Hematuria

• Edema

POSTRENAL ACUTE FAILURE

Progression

• Hyperkalemia

• Acidosis

• Arrhythmias

• Cardiac arrest

(Core EM, 2018)

ACUTE KIDNEY STONES

Develop in renal pelvis

• Crystallization of insoluble

salts or uric acid in urine

Causes

• Poor hydration

• Frequent urinary tract

infections

• Frequent catheterizations

• Associated with gout

(Crosta, 2017)

KIDNEY STONES

Signs and Symptoms

• Rapid onset pain • Groin

• Lower Flank

• Genitalia

• Guarding

Treatments

• Fluids

• Naturally passed

• Surgical intervention

CHRONIC RENAL FAILURE

Irreversible impairment of nephrons

Causes

• Diabetes

• Hypertension

• Congenital disorders

• Prolonged pyelonephritis

CHRONIC RENAL FAILURE

Signs and symptoms

• Lethargy

• Nausea

• Headaches

• Cramps

• Altered mental status

• Electrolyte imbalance

CHRONIC RENAL FAILURE

Treatments

• Supportive care similar to

acute renal failure

• Dialysis

• Kidney transplant

(Medical News Today, 2018)

KIDNEY TRANSPLANTATION

Data as of 4/26/18

• 95,099 people on the kidney organ

transplant list

• 8,509 organ transplants this year

• Living / deceased donors

(OPTN, 2018)

DIALYSIS

External filtration of toxins, fluid management, and restores electrolyte balance

Peritoneal Dialysis

(Lucenxia, 2018)

Hemodialysis

PERITONEAL DIALYSIS

Process

• Large amount of

dialysis fluid infused into

abdomen

• Fluid settles and

exchanges toxins

• Drained out

Risk for Peritonitis

(Dreamstime, 2018)

HEMODIALYSIS Process

• Access

• Filtered through

machine

• Ph Balanced

• Excess fluid removed

• Returned to Patient

Required every 2-3 days

(E-Health Hut, 2018)

HEMODALYSIS

Procedure Complications

• Hypovolemic Shock

• Infection

• Bleeding

Missed Appointments

• Electrolyte imbalances

• Fluid overload

• Arrhythmias / shock

RENAL TRAUMA

Renal vascular injuries

Assessment Keys

• Flank Pain

• Grey Turners sign

• Hematuria

HEMATOLOGY THE STUDY OF BLOOD

COMPONENTS OF BLOOD

(Quora, 2018)

PLASMA

Components

• Water

• Proteins

• Electrolytes

• Clotting factors

• Glucose

RED BLOOD CELLS (RBC)

Erythrocytes

Oxygen carrying capacity

• Hemoglobin

WHITE BLOOD CELLS (WBC)

Leukocytes

• Immune response

Types of WBC

• Monocytes

• Lymphocytes

• Neutrophils

• Basophils

• Eosinophils

PLATELETS

Thrombocytes

Function

• Clotting cascade

CLOT FORMATION

(BioNinja, 2018)

TRANEXAMIC ACID- TXA

Promotes clotting

• Prevents breakdown of fibrin

Carried on all LifeNet Helicopters

(Cohen, 2014)

TIME IS TISSUE

Stroke

Heart Attack

Pulmonary Embolism

DVT

HEMATOLOGY RELATED DISEASES

Sickle Cell

Hemophilia

Anemia

Thrombocytopenia

Leukemia

(Getty Images, 2018)

SICKLE CELL

Red blood cell changes

• Sickle shaped

• Rigid

• Sticky

Impact on body

• Decreased oxygen transport

• Anemia

SICKLE CELL CRISIS

Inadequate blood flow to vital organs

Assessment Keys

• Dyspnea

• Pain

• Fever

• Jaundice

(Oneal, 2017)

SICKLE CELL CRISIS

Treatment

• High flow O2

• Fluids

• Warm compress

• High dose analgesia

HEMOPHILIA

Decreased ability to form blood clots

Type A

• Low levels of factor VIII

Type B

• Low levels of Factor IX

ANEMIA

Low blood count

• Ineffective production

• Blood loss

• Medication induced

Acute / chronic in nature

Assessment keys

• Fatigue

• Dyspnea

• Pale skin / mucus membranes

THROMBOCYTOPENIA

Low platelet count or increased platelet breakdown

Assessment Keys

• Abnormal Labs

• Bruising

• Excessive bleeding

LEUKEMIA

Cancer of the blood forming tissues

White blood cell abnormalities

Can cause

• Thrombocytopenia

• Anemia

• Frequent fever & bruising

BLOOD TYPE AND CROSS

A- Antibody

B- Antibody

Positive / Negative

O- Universal Donor

AB+ Universal Recipient

TRANSFUSIONS FFP – Fresh Frozen Plasma

PRBC- Packed Red Blood Cells

Platelets

Cryoprecipitate

Whole Blood

Transfusion Reaction

AMERICAN RED CROSS

RedCrossBlood.org

Locate donation centers or blood drives

BLOOD DONATION

Types of collections

• Whole blood

• Power red

• Platelets

• AB elite plasma

WHOLE BLOOD DONATION

How it works?

Who are they used for?

• Trauma / surgical patients

How long does it take?

• 1 hour

Ideal donor blood type?

• All blood types

POWER RED DONATION

How it works?

Who are they used for?

• Trauma, newborn, sickle cell patients

How long does it take?

• ~1.5 hours

Ideal donor blood type?

• O+/-, A-, B-

PLATELET DONATION

How it works?

Who are they used for?

• Cancer / low platelet patients

How long does it take?

• ~2.5 - 3 hour

Ideal donor blood type?

• A+/-, B+, O+, AB+/-

AB ELITE PLASMA DONATION

How it works?

Who are they used for?

• Trauma / uncontrolled hemorrhage patients

How long does it take?

• ~1.25 hours

Ideal donor blood type?

• AB +/-

LAB VALUES

WBC HGB

HCT PLTS

Hemoglobin (HGB)-

• Male: 14-17

• Female: 12-16

LAB VALUES

WBC HGB

HCT PLTS

Hematocrit (HCT)-

• Male: 40-50%

• Female: 36-46%

LAB VALUES

WBC HGB

HCT PLTS

White Blood Cell (WBC)-

• Male: 4-11

• Female: 4-11

LAB VALUES

WBC HGB

HCT PLTS

Platelets (PLTS)-

• 140,000 – 450,000 /ml

LAB VALUES

What does this all mean?

• Low Hgb / Hct

• Abnormal WBC

• Abnormal platelets

WBC HGB

HCT PLTS

SUMMARY

• Anatomy and physiology of the renal system

• Common acute / chronic renal failure conditions

• Treatments for renal failure

• Renal trauma

SUMMARY

• Introduction to hematology

• Components that make up blood

• Common hematological emergencies

• Treatment for hematological emergencies

• Blood product transfusion

• Blood donation

• Basic lab values

QUESTIONS: