EMERGENCY AND CRITICAL CARE
EMERGENCY AND CRITICAL CARE
Embedded Files
RENAL SUPPORT
RENAL SUPPORT
Introduction
5 minIntroduction
Introduce yourself and the group
Provide rationale for the session and relevance to clinical practice
Outline learning objectives:
- Demonstrate a systematic approach to assessing a patient with acute kidney injury
- Recognise common causes of acute kidney injury and stratify severity
- Understand initial investigations of acute kidney injury
- Understand initial management of acute kidney injury including recognising indications for renal replacement therapy
Explain structure of session
Total time:
60 minNumber of students:
1-5Grade of students:
3rd to 5th year medical studentsCreated by:
Dr Max ByrneUploaded:
7th February 2020Last updated:
7th February 2020Resources needed for this session:
Resources needed for this session:
Patient
Resources linked to this session:
Resources linked to this session:
Activity 1: Background Discussion
10 minActivity 1: Background Discussion
Ask the student(s) to review their knowledge of acute kidney injury.
- What causes of acute kidney injury can they recall?
- How can causes be classified?
- What questions are important to ask in a history of a patient with suspected acute kidney injury? (Encourage students to think of symptoms of underlying causes as well as symptoms of acute kidney injury itself)
- What signs are important to assess for in patients with acute kidney injury? Consider signs relevant to a fluid assessment and underlying cause)
Activity 2: Clinical Assessment
20 minActivity 2: Clinical Assessment
Ask the student(s) to take a focused history from a patient with acute kidney injury. Encourage them to ask questions relating to the underlying cause and effects of acute kidney injury.
Ask the student(s) to examine the patient for key clinical signs discussed earlier, if possible.
If no patient is available, consider role-playing a patient with acute kidney injury.
Activity 3: Investigations
10 minActivity 3: Investigations
Ask the student(s) to discuss relevant investigations for the patient they have seen. Try to encourage them to categorise them into:
- bedside e.g. urine dip
- blood tests e.g. U+Es
- imaging e.g. USS KUB
- specialist tests e.g. vasculitis screen, renal biopsy
Activity 4: Case-Based Discussion
10 minActivity 4: Case-Based Discussion
Discuss with students:
- What is the initial management of a patient with AKI? Consider general management and that specific to some of the most common underlying causes such as sepsis, obstruction and intrinsic renal causes.
- How should patients with AKI be monitored?
- What are the complications of acute kidney injury? Consider short-term and long-term complications.
- When might intensive care support be indicated?
Activity 5: Understanding Renal Replacement Therapy
10 minActivity 5: Understanding Renal Replacement Therapy
Encourage students to suggest the difference between haemofiltration and haemodialysis. Correct any inaccuracies using diagrams if required.
Key discussion points:
- the role of anticoagulation
- key physiological concepts such as diiffusion, convection, filtration
- types of central access lines including vascaths
Ask a knowledgable nurse or filter operator to demonstrate to students important parts of the filtration machine.
Summary and Feedback
5 minSummary and Feedback
Questions
Identify and summarise key learning points (key three points if possible)
Feedback to student – highlight further learning needs
Feedback for teacher - ask students to provide feedback using the QR code opposite
Close
References and Further Reading
References and Further Reading
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