Case discussion
Posted: 08 Oct 2012, 02:08
Hello... Finally, after a long wait I can download from your wonderful site thanx a lot and god bless you. but some videos and big books don’t be downloaded fully, might come out of bad network ..
Today I want to discuss with you case of pulmonary edema due to ESRD.. Unfortunately i dont remember a lot of things about her story because i see her for a short time :
A lady of 20 years old “but she looks younger” she has delivered 2 months ago NVD ,,before delivery she was quite well as her family mentioned. After delivery she diagnosed as ESRD “i don’t know the symptoms “during these 2 months she only recieve 3 to 4 sessions maximum, when she came to us her last session was 1 month ago (her family said because she refuse dialysis)
she admitted at 10 pm, presented with one day history of SOB, she was dyspnic pale her BP and PR within normal,O2 sat 88 and sometimes reach 96 in room air.i dont remember full examination but there was clear basal (coarse) crepitations...inv: s.urea 300 cr:13 s.k:3.5 hb 6 ..they call renal unit and they ask for viral screening, blood sample was taken,..unfortunately the result come back after 1:30 am (only hiv because the lab which have the results of HBV & HCV is closed!!)and renal unit hasn’t night shift they only work till 12am but they wait the pt till 1 :30 am ..
The pt remain whole the night dyspnic in sitting position, she said that she had urine output ,, receive o2 and lasix 100 mg .but she was uncooperative and refuse urinary catheter to calculate output, and sometimes refuse o2,vitaly was stable. in the next day,, HD was at about 1 pm ..and after the session she return back more dyspnic!!I don’t know how the progression was, but they told me that at 4 am of the next day she arrested! they said that she had been talking to the last breath then suddenly collapsed and arrested..but i got angry and surprised when they told me that CPR was not don bcause she is ESRD! although i never see (but i hear some stories)pt return and not arrested again after CPR, but i think that is the least thing we can do , specially in young pt with only one organ failure!
Sorry if it was long , incomplete story, and may be not useful..but I want to ask some Q:
What is the direct cause of death in ESRD specially in this case pulmonary edema
If she get HD session earlier than that, the results may changed?(i know it’s her day to pass away ”Qadaa w qadar”)but i mean her death because delay in management or because she is terminal?
Why she become more dyspnic after session?
And finally is it real ESRD not for CPR??!
Thank you.
Today I want to discuss with you case of pulmonary edema due to ESRD.. Unfortunately i dont remember a lot of things about her story because i see her for a short time :
A lady of 20 years old “but she looks younger” she has delivered 2 months ago NVD ,,before delivery she was quite well as her family mentioned. After delivery she diagnosed as ESRD “i don’t know the symptoms “during these 2 months she only recieve 3 to 4 sessions maximum, when she came to us her last session was 1 month ago (her family said because she refuse dialysis)
she admitted at 10 pm, presented with one day history of SOB, she was dyspnic pale her BP and PR within normal,O2 sat 88 and sometimes reach 96 in room air.i dont remember full examination but there was clear basal (coarse) crepitations...inv: s.urea 300 cr:13 s.k:3.5 hb 6 ..they call renal unit and they ask for viral screening, blood sample was taken,..unfortunately the result come back after 1:30 am (only hiv because the lab which have the results of HBV & HCV is closed!!)and renal unit hasn’t night shift they only work till 12am but they wait the pt till 1 :30 am ..
The pt remain whole the night dyspnic in sitting position, she said that she had urine output ,, receive o2 and lasix 100 mg .but she was uncooperative and refuse urinary catheter to calculate output, and sometimes refuse o2,vitaly was stable. in the next day,, HD was at about 1 pm ..and after the session she return back more dyspnic!!I don’t know how the progression was, but they told me that at 4 am of the next day she arrested! they said that she had been talking to the last breath then suddenly collapsed and arrested..but i got angry and surprised when they told me that CPR was not don bcause she is ESRD! although i never see (but i hear some stories)pt return and not arrested again after CPR, but i think that is the least thing we can do , specially in young pt with only one organ failure!
Sorry if it was long , incomplete story, and may be not useful..but I want to ask some Q:
What is the direct cause of death in ESRD specially in this case pulmonary edema
If she get HD session earlier than that, the results may changed?(i know it’s her day to pass away ”Qadaa w qadar”)but i mean her death because delay in management or because she is terminal?
Why she become more dyspnic after session?
And finally is it real ESRD not for CPR??!
Thank you.
