critical situation

[diabo, RN]

I learned a new trick the other night. I was called to ICU at midnight to run an out of town dialysis patient that was in trouble. Small thirty year old. She was very close to being intubated, and according to her stated WDW in the ER, she was around 7 kgs over, and drowning. BP was high at 10 pm so she was given Loniten which gave her a BP of 92/48 by the time I got to her. Dr. said to UF only, to try to get a couple of kgs, but when he saw the BP, he said to make an attempt if I felt comfortable, and he okey'd my stratagy. She was in a fair amount of distress. Albumin was 2.2, so after getting her on and upping the sodium, I gave her a wide open 12.5 GM. Since Loniten dialyzes out, I ran her in minimum UFR for thirty minutes to see if pulling the stuff off would help, taking B/Ps Q 15 min. Thirty minutes later 118/64. So I was able to begin mirroring my UF to the B/Ps. Ended up pulling 3 1/2 off in three hours, uf only, last hour. I ran her again the next day, and she went out to the floor without even a nasal cannula. I'm really not bragging, but I was delighted that it worked. Just a bunch of common sense stuff really. I live for success stories.

Steve

[FNimuaeMae]

Thats a really cool story! I'm not a dialysis nurse, but work ICU, and have done some SLED monitoring and CVVH. Nice when you can get a good outcome. Dialysis is fascinating to me...

Missy:)

[dialysisalice]

"You da Nurse"!! Great job, crit lines work great in this situation too, if you have them.

[tinamacRN]

:yeah: :yeah: :yeah:

Excellent.

[NephroBSN, BSN, RN]

I learned a new trick the other night. I was called to ICU at midnight to run an out of town dialysis patient that was in trouble. Small thirty year old. She was very close to being intubated, and according to her stated WDW in the ER, she was around 7 kgs over, and drowning. BP was high at 10 pm so she was given Loniten which gave her a BP of 92/48 by the time I got to her. Dr. said to UF only, to try to get a couple of kgs, but when he saw the BP, he said to make an attempt if I felt comfortable, and he okey'd my stratagy. She was in a fair amount of distress. Albumin was 2.2, so after getting her on and upping the sodium, I gave her a wide open 12.5 GM. Since Loniten dialyzes out, I ran her in minimum UFR for thirty minutes to see if pulling the stuff off would help, taking B/Ps Q 15 min. Thirty minutes later 118/64. So I was able to begin mirroring my UF to the B/Ps. Ended up pulling 3 1/2 off in three hours, uf only, last hour. I ran her again the next day, and she went out to the floor without even a nasal cannula. I'm really not bragging, but I was delighted that it worked. Just a bunch of common sense stuff really. I live for success stories.

Steve

Gotta love that Albumin and sodium modeling..LOL But don't ya hate it when the Doc wants you to run in the albumin over the full four hours.. OMG.

JMHO

[blueheaven]

Good for you!! I just love it when things work like they should and we get a good outcome!! (such a boost for all the other times when things don't work out quite as well)

Peace