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Dutchess Community College EMS
Urology
Dutchess Community College EMS
Sections
Anatomy and Physiology
General Mechanisms of Nontraumatic Tissue Problems
General Pathophysiology, Assessment, and Management
Renal and Urologic Emergencies
Dutchess Community College EMS
Anatomy & Physiology
The Urinary System Female Male
Urology & Nephrology
The Kidneys
Dutchess Community College EMS
The Kidneys
Dutchess Community College EMS
Nephrons
Dutchess Community College EMS
Anatomy & Physiology
Functions of the Kidneys Forming and Eliminating Urine
Maintaining blood volume with proper balance of water, electrolytes, and pH.
Retaining key compounds such as glucose, while excreting wastes such as urea.
Controlling Arterial Blood Pressure Regulating Erythrocyte Development
Dutchess Community College EMS
Anatomy & Physiology
Formation of Urine Glomerular Filtration
GFR Reabsorption & Secretion
Simple diffusion and osmosis Facilitated diffusion
Active transport
Dutchess Community College EMS
Anatomy & Physiology
Tubular Handling of Water and Electrolytes Diuresis and Antidiuresis
Tubular Handling of Glucose and Urea BUN and Creatnine
Control of Arterial Blood Pressure The Renin-Angiotensin System
Control of Erythrocyte Production Erythropoietin
Dutchess Community College EMS
Dutchess Community College EMS
Inflammatory or Immune-Mediated Disease
Infectious Disease
Physical Obstruction
Hemorrhage
General Mechanisms of Nontraumatic Tissue Problems
Dutchess Community College EMS
Differentiating GI and Urologic Complaints
Pathophysiologic Basis of Pain Causes of Pain Types of Pain
Visceral pain Referred pain
General Pathophysiology, Assessment and Management
Dutchess Community College EMS
Scene Size-upInitial AssessmentFocused History OPQRST History Prior History of Similar Event History of Nausea, Vomiting, and Weight Loss Change in Bowel Habits and Stool Last Oral Intake Presence of Chest Pain
Assessment and Management
Dutchess Community College EMS
Physical Exam Appearance
Uncomfortable appearance. Posture
Lying with knees drawn up. Relief with walking.
Level of Consciousness Determine if changes are acute or chronic.
Assessment and Management
Dutchess Community College EMS
Physical Exam Apparent State of Health Skin Color Examination of the Abdomen
Inspection for distention, ecchymosis, or scarring Pain associated with percussion of abdomen Palpation
Normal or ectopic pregnancy Masses
Assessment Tools Vital Signs
Assessment and Management
Dutchess Community College EMS
Management Airway, Breathing Circulation Pharmacologic Interventions
IV access and analgesics. Nonpharmacological Interventions
Nothing by mouth (NPO). Maintain position of comfort. Reassess mental status and vital signs frequently.
Transport Considerations
Assessment and Management
Dutchess Community College EMS
Risk Factors Older Patients History of Diabetes History of Hypertension Multiple Risk Factors
Renal and Urologic Emergencies Acute Renal Failure Chronic Renal Failure Renal Calculi Urinary Tract Infection
Renal and Urologic Emergencies
Dutchess Community College EMS
Acute Renal Failure
Pathophysiology Prerenal Acute Renal Failure
Dysfunction before the level of kidneys Most common and most easily reversible
Renal Acute Renal Failure Dysfunction within the kidneys themselves
Postrenal Acute Renal Failure Dysfunction distal to the kidneys
Dutchess Community College EMS
Acute Renal Failure
Dutchess Community College EMS
Acute Renal Failure
Assessment Focused History
Change in urine output Swelling in face, hands, feet, or torso Presence of heart palpitations or irregularity Changes in mental function
Dutchess Community College EMS
Acute Renal Failure Physical Assessment
Altered mental status Hypertension Tachycardia ECG indicative of hyperkalemia Pale, cool, moist skin
Dutchess Community College EMS
Acute Renal Failure
Physical Assessment Edema of face, hands, or feet Abdominal findings
dependent on the cause of ARF
Dutchess Community College EMS
Acute Renal Failure
Management Airway, Breathing, Circulation IV Access
Protect fluid volume. Positioning and Transport
Dutchess Community College EMS
Chronic Renal Failure
Chronic Renal Failure Permanent Loss of Nephrons End-Stage Renal Failure (ESRF)
Pathophysiology Similar to Renal ARF
Microangiopathy, glomerular injury Tubular cell injury Insterstitial injury
Dutchess Community College EMS
Chronic Renal Failure
Dutchess Community College EMS
Chronic Renal Failure
Impairment of Kidney Functions Maintenance of blood volume with proper balance
of water, electrolytes, and pH Increased sodium, water, and potassium retention
Retention of key compounds such as glucose with excretion of wastes such as urea
Loss of glucose and buildup of urea within the blood Control of arterial blood pressure
Disruption of the renin-angiotensin loop resulting in HTN Regulation of erythrocyte development
Development of chronic anemia
Dutchess Community College EMS
Chronic Renal Failure
Assessment Differentiate chronic and acute problems. Focused history and physical exam.
Gastrointestinal complaints Changes in mental status Marked abnormalities during physical exam Uremic frost
Dutchess Community College EMS
Dutchess Community College EMS
Dutchess Community College EMS
Chronic Renal Failure
Immediate Management Monitor and support ABCs. Establish IV access.
Regulate fluid volume. Monitor vital signs and cardiac rhythm. Expedite transport to an appropriate facility.
Dutchess Community College EMS
Chronic Renal Failure
Long-Term Management Renal Dialysis
Hemodialysis Common complications
Dutchess Community College EMS
Hemodialysis
Dutchess Community College EMS
Chronic Renal Failure
Long-Term Management Renal Dialysis
Peritoneal dialysisCommon complications
Dutchess Community College EMS
Peritoneal Dialysis
Dutchess Community College EMS
Renal Calculi
Pathophysiology Results when “too much insoluble stuff”
accumulates in the kidneys. Stone types
Calcium salts Struvite stones Uric acid Cystine
Dutchess Community College EMS
Renal Calculi
Dutchess Community College EMS
Renal Calculi
Assessment Focused History
Severe pain in one flank that increases in intensity and migrates from the flank to the groin
Painful, frequent urination with visible hematuria Prior history of calculi
Physical Exam Difficult due to patient discomfort Tachycardia with pale, cool, and moist skin
Dutchess Community College EMS
Renal Calculi
Management Maintain ABCs. Maintain position of comfort. Establish IV access.
Fluid bolus may promote stone movement and urine formation.
Consider medication administration. Parenteral narcotic analgesics may be indicated.
Dutchess Community College EMS
Urinary Tract Infection
Pathophysiology Risk Factors
Increased risk in female or catheterized patients Sexual activity
Lower and Upper UTIs Urethritis Cystitis Prostatitis Pyelonephritis Community-acquired vs. nosocomial infections
Dutchess Community College EMS
Urinary Tract Infection
Assessment Focused History
Abdominal painFrequent, painful urinationA “burning sensation” associated with
urinationDifficulty beginning and continuing to voidStrong or foul-smelling urineSimilar past episodes
Dutchess Community College EMS
Urinary Tract Infection
Physical Exam Restless, uncomfortable appearance. Presence of a fever. Vital signs vary with degree of pain.
Management Maintain ABCs. Establish IV access. Consider analgesics. Transport to appropriate facility.
Dutchess Community College EMS
Urology and Nephrology Review
Anatomy and Physiology
General Mechanisms of Nontraumatic Tissue Problems
General Pathophysiology, Assessment, and Management
Renal and Urologic Emergencies