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ER diaries : Facepalms- Hemodialysis

Heyyyya!

There was this 60yr old man . Fever  cough and weight loss history 
On hemodialysis history
I ask him routine questions...
Fever  ?
Cough   ?
Intermittent ?
Body pains  ?
Chest pain ?
difficulty in breathing  ?
Urine me jalan hai kya ?
N he is like 
Madam , main dialysis pe hu... merko urine Nai aata !

I was in this awkward face palm situation blabbering senselessly like a pet parrot!

This made me feel like a fool to be honest. I rush home zero down to hemodialysis . Read about it like it’s the last day on the planet and if I don’t read it today. The death angel will take me nowhere but hell!

  • Because the patients on hemodialysis constituted good number of cases reporting tonER in pulmonary edema and altered sensorium. The only thing that would give respite to them was hemodialysis. Rest all was temporary management.


  • Read about how important asking about fistula is !  It’s like a second heart frankly. You don’t touch it . You don’t poke it for cannulation. Don’t even check BP from the hand that has fistula. Otherwise you push the patient in hemodynamic emergency.

Days later another 60year old lady turns up to ER.
She apparently had slip and fall at home following which she sustained injury to left arm 1 day back . She had no head injury to head/ LOC/ ENT bleed/ vomit / seizures / chest pain. KNown case of CAD / DM / HTN / status post coronary artery bypass surgery. Tobacco addiction.

Since she was hemodynamically stable. 

Examination
The hand showed dinner fork deformity.
Distal pulses were feeble.
There was swelling and tenderness.
 She was sent for a X-RAY. She turns up after 30 min.

The X-ray : Distal 2.5 cm fracture of radius. It was difficult to call it Colles as such.
So we called up the Orthopedics surgeon. He told the Case required surgery.

Tell the name of the surgery . You’ll see the calmest of the lot losing their mind and run amok. The same was explained to the attendants. Her son was initially Hesitant but eventually agreed. This news had to be broken down to the patient. When he said the same to her.

She looked at her like my mom looks at me when I have broken a glass or something. She said , sun to... asking him to come closer. She scolded him but in whispers.we heard nothing.

Few minutes later , the son turns up .
Pattti baandh dijiye. Pain management dedijiye . Ghar jaana hai.

She didn’t agree.
It seemed obvious too. Status post CABG , hemodialysis, who would take a pain of going under the knife once again. It would be a very high risk surgery. Despite of having insurance, they refused.
So far so awkward
Bye!
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