Hey guys. I'm Siobhan, a second year medical resident. I just got to the hospital.
It is the weekend and I'm on nephrology call.
So this is the specialty that deals with kidneys and often has to do with when kidneys don't work, so kidney failure.
So let's start out, I'm gonna print off some patient lists and get myself organized before the staff physician is here.
The morning is dedicated to seeing our admitted patients, unless we are paged to see a new patient in the emergency department.
The patient had black tarry stools overnight, nursing confirmed stools look like melena.
No abdominal pain, no vomiting, no history of liver disease or esophageal varices.
Hemoglobin had dropped 12 points since yesterday, blood pressure and heart rate are stable, repeat hemoglobin is ordered for six hours from now.
Sixty-two year old man with end-stage renal disease secondary to diabetes.
Newly started on hemodialysis three times per week, he tolerated his last session well.
So what is dialysis?
Basically it's a machine that filters the blood and can act like a kidney replacement.
Normally kidneys are responsible for balancing your electrolytes, like sodium and potassium,
getting rid of toxins and maintaining the right amount of fluid in your body.
So if you go to the movies and have a whole bunch of popcorn or soda,
your kidneys will actually pee out the extra salt and water that your body doesn't need.
But at the end of the day, without kidneys a person cannot survive.
Potassium will build up into the body and that will cause the heart to stop and
without peeing, all that fluid stays in the body and eventually fills up the lungs.
That's why dialysis is so incredible.
In hemodialysis, blood gets pumped out of the body through a filtration process and then comes back into the body again.
This happens at a speed of 400 milliliters per minute, which is totally mind-blowing.
The whole process takes three or four hours and it needs to be completed about three times per week.
I'm heading down to the emergency department to see a patient who is on hemodialysis three times a week.
Now unfortunately, the patient wasn't feeling well and missed two sessions.
So now they're coming in very short of breath, because all this fluid is reaccumulating in their body.
Examining the patient I can hear crackles in her lungs and see swelling in her legs from the build-up of fluid.
Her blood work also shows a high potassium, high phosphate, high urea and low red blood cell count.
All signs of kidney failure.
Hi, can you please put me through to hemodialysis, please? Thanks.
So much waiting to put through things.
Oh hey, it's Siobhan from nephrology, I'm the resident on-call.
Yeah, so I just saw a patient in the emergency department who's missed their last two
sessions of hemodialysis. Is it possible for you to
squeeze her in today, either this afternoon or maybe this evening?
Mmm great.
Fantastic!
It's 3:30 pm, lunch finally got here. We just ordered and I've got some great Thai food.
So the staff nephrologist and the nephrology fellow just went home.
We've had a chance to see all of our inpatients and make a plan for them all,
which has been so helpful during the day. I'm sure it will be helpful tonight as well.
Now I've got two new patients to see: one is down in the emergency department and the other ones in the ICU.
Okay, so done seeing the patient in the emergency department. It's pretty clear that they need dialysis today,
so we're going to call and make that happen.
But now I'm gonna head down to the ICU and this is different.
This is someone who never had kidney disease before, but now has developed an acute kidney injury and the question is:
Do we need to start dialysis or do we wait to see if the kidneys are gonna turn around? And it's a delicate balance.
There's a handy acronym I always use to remember the indications for dialysis and that's AEIOU.
So acidosis, where you have a low pH in the blood that isn't responding to fluids or medications.
Electrolyte abnormalities, we mainly care about the high potassium.
Intoxications, things like an aspirin overdose.
Overload, so too much fluid in the body that get in the lungs.
Uremia, with high levels of urea and that can cause vomiting, confusion,
abnormal bleeding or even heart problems.
In this case, going through this list, the patient doesn't meet criteria for dialysis at this time.
So we'll be continuing to do bloodwork and watch and see if things change.
Ten o'clock at night, managed to get myself some Tim Horton's before
everything closes down for the night. Otherwise I would have been so hungry.
I wish I'd been more prepared to be able to actually make myself a healthy meal, but honestly
sometimes it just feels like it's too much and you just can't do it all. I think this is one of those weekends.
Just trying to survive at this point. I'm not gonna jinx myself
like I did the other night.
But I will say that I don't have anything really going on at the moment and I'm gonna take advantage of this and
go find a call room for the first time.
Oh actually, what am I doing?
I have to get a call room key first, oh boy!
Hey, can I get a call room key for nephrology?
Alright, I just need to grab my bag and then finally go put my feet up.
I'm pretty sure that's the emergency department.
Oh just my luck. Okay, let's just rip the band-aid off, see what they have to say.
Hey, this is Siobhan from nephrology returning a page.
Sure, they're just paging the emerge doctor.
Alright, sounds good. Yeah, I'll come see him. Thanks. Alright, bye.
So a patient with an extremely high blood pressure,
doesn't seem to be having any symptoms, but emerge just doesn't really feel comfortable sending this patient home,
they're on dialysis. So I'm gonna go take a look and see what we can do to help.
Okay, take two.
Let's try to go to sleep, actually go to the call room for the first time.
So I'm going to go and talk with the nurses and see if they have any issues, so maybe I won't get paged.
It's my little technique that I've learned.
Just checking, communicate,
people are nice to you then.
It's literally been five minutes.
I guess it's better than actually falling asleep and getting paged.
Luckily it was just a quick clarification on the phone. Okay, fingers crossed.
So it's 7:15 now. I set my alarm for this time,
so I have 30 minutes to be able to get myself organized and look at morning blood work before I hand over to the team.
And then I also get to follow up on the new patients and see how they're doing.
Finally done! Oh, such a relief after being on call Friday and Sunday this week.
Oh, I can't wait to just go home and sleep and get back to my normal routine.
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comment, say hi. Let me know if you have any questions, because I really love hearing from you guys.
Anyway, I'll be chatting with you guys next week. So bye for now!