RCEM Learning January 2025
15 snips
Jan 8, 2025 
Becky Maxwell, an expert in emergency medicine, and Chris Connolly, an emergency medicine physician, dive deep into the updated NICE guidelines on acute kidney injury (AKI). They emphasize the importance of timely imaging and collaboration across specialties for improved patient outcomes. The duo also navigates the challenges of diagnosing kidney issues, including creative alternatives for obtaining ultrasounds. Additionally, they tackle the complexities of assessing febrile infants and the evolving clinical decision aids that support physicians in pediatric emergency care.
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Fluid-Protect High-Risk Contrast Patients
- Give IV fluids to higher-risk patients receiving contrast: GFR <30, transplant, high contrast volume, or intra-arterial use.
- Discuss contrast risks and benefits with patients when feasible.
Early Urine, Imaging, And Specialist Referral
- Do a urine dip and consider nephrology referral for blood/protein without UTI, and ultrasound for suspected obstructive infected kidneys within 6 hours.
- Use CTKUB when ultrasound isn't available out of hours.
Avoid Routine Diuretics And Dopamine
- Avoid routine loop diuretics or low-dose dopamine for AKI treatment.
- Refer early to nephrology/ICU for potential renal replacement needs and use KDIGO staging to trigger referral.