A 52-year-old man with diabetes, hypertension, end-stage renal disease on dialysis, and CAD presents to the ED with sudden onset of shortness of breath. He endorses missing his last dialysis session because he left the country for a week and was forced to pay for his last session out-of-pocket in Jamaica. Your history is otherwise limited due to extreme respiratory distress. He shakes his head ‘no’ when asked if he has any chest pain.
His vital signs are: BP: 194/96. HR: 84. RR: 26. O2 saturation: 85% on room air. Temp: 97.5 F. He has diffuse rales in all lung fields. A bedside ultrasound shows diffuse B-lines and poor cardiac contractility without pericardial effusion. You place him on BiPAP and intravenous nitroglycerin, while you call the renal service for emergent dialysis. You obtain an ECG, which shows tachycardia but no signs of acute ischemia. You obtain blood for testing.
Does this patient’s clinical presentation necessitate inpatient admission?
If you would consider discharging this patient after dialysis, which parameters would you use to reassess?
Are there any factors that you can use to predict this patient’s need for admission or candidacy for potential discharge after dialysis?
Post an answer/comment and receive points toward asynchronous learning credit (if you have have contributed to other “Cases, Controversy, and Conversation” posts, your points do accumulate).
10 points = 1 hour credit
1 point for relevant answer/comment
5 points for also citing a reference to a relevant online resource(s) or journal article(s)
Latest posts by kkelson (see all)
- Is “Epi” Killing Your Patient? - November 30, 2017
- The Crashing Calcium Channel Blocker Overdose Patient - November 9, 2017
- Ibuprofen for Acute Mountain Sickness? - October 28, 2017