Until we know. So the first thing I'm going to
talk about is kidney biopsies. Kidney biopsies.
Well why are kidney biopsy so important.
So in general, If we do a kidney biopsy, what is it?
Post-op post procedure. So if I'm looking at a patient
that's post-op, post procedure in general, forget kidney
biopsies, what's pneumonic that we're looking for good.
Ash. So kidneys liver any type of
biopsy. Lung, what are these organs
their highly vascular, right to highly vascular, which means
that there's a lot of room for error.
And, but in general post-op, post procedure.
We're looking at Ash because what's a mnemonic?
Do not let your patience turn. To ashes.
So Airway is above all else. Why?
If I'm going to get a biopsy? Well, maybe I have to sedate
them. I may even have to intubate
them. Nonetheless, I'm worried about
their Airway Airway Airway, and that is above all else.
Always number one, the remainder.
You find me one of those The next one is what altered mental
status. Well again we've given the
medication, we've sedated them. Maybe they come out and they are
disoriented or whatever. All of a sudden with what just
happened. What just happened.
The next one is Sepsis. Well yeah, we just did an
invasive procedure. So of course there's going to be
the ability to have sepsis because we may be able to
introduce bacteria fungi, violent reaction into their
bloodstream. Right?
And with sepsis what's my Triad? Where is ninety?
Six point eight and below? Or 100.4 and above.
So you can hypothermia core you could be febrile, right?
What are the other two signs? Hypotension tachycardia.
But in sepsis you think the boys are just gonna be like oh yeah
it's person is septic and they have 100.6 and their blood
pressure 60 over 30 and a heart rate is 127.
No. That would be too easy.
What are you going to say at the incision site?
There's purulent discharge and they have a fever of 100.6.
Hmm. Logical deduction.
Critical thinking. Yeah.
Absolutely. Absolutely.
So you have to be able to figure it out.
Hemorrhage. Highly, vascular organs kidney,
lung liver. If you do a biopsy and a highly
vascular. Do you think there's a risk for
causing Hemorrhage? Absolutely.
So now, if I do a kidney biopsy, since we're doing renal, what
are the signs and symptoms of hemorrhage?
Hypotension and tachycardia. So this person is going to come
out. Do you think that they're just
going to say? Oh this person is hemorrhaging
and their blood pressure is down, the heart, rate is up,
know what they're going to say. Is this person is post-op.
Well, we're going to see first initial priority urgent.
Most concerning immediate report to hcp and their post-op after a
kidney biopsy and their blood pressure is 60 over 30.
Now, it's up to you to realize that this person is
hemorrhaging. It's up to you.
To realize this person is hemorrhaging specifically with
kidney biopsies because it's a highly vascular organ. now, my
question is, On the boards. Remember, when I tell you, this
is how the board's would ask this question.
You better start that in your notes on the boards, this is how
I would ask it, or this is how you're going to see a question.
Dka. Hemorrhage sepsis.
What do we do first? Fluids, fluids fluids with dka.
What are they going to try to trick you with insulin
potassium? Right?
But no, you're not going to do that.
You're going to give them what fluids first.
Hemorrhaging, what are they going to try to trick you with?
Blood. Yeah.
Give them blood. And then, which sepsis what are
they going to try to trick you with?
Antibiotics good. So these are bored favorites
board favorites. So do not fall for those traits.
Do not fall for those tricks because they are commonly asked
questions and they will be in the answer choices and you're
going to look at them like, oh wait this person's had dka.
Maybe I should give them and to what's it called insulin first?
No, no, no, just think about real life.
If somebody comes into the the ER, what are you gonna do first?
You're gonna get intravenous access.
And you're going to do what start fluids, always think about
that. It's in general, and general DK,
sepsis and Hemorrhage. Always get fluids first do not
fall for that trick. With kidney biopsies.
Post-op how often are we going to check vitals for the first
hour? Every 15 minutes. 15 minutes is
quite Regular, and it's frequent. so Q, 5:15 is very
high frequency because again, why we're dealing with the
highly vascular organ. We're dealing with a highly
vascular organ. If?
We are going to do a kidney biopsy.
What must, what must we obtain? Good.
Informed consent. Informed consent. if a patient
is going to get a kidney biopsy and is on an anticoagulant, what
are some anticoagulants just run-of-the-mill?
And sense which include aspirin. How about your War friend?
Capito Grill. Good Clopidogrel is a good one
Clopidogrel. So, Warfarin Clopidogrel,
NSAIDs, which include aspirin. Yeah, your apixaban.
All of these are going to be an indication operon I wouldn't say
because why I'm not concerned about Heparin.
I don't think it'll be there unless you're already
hospitalized and on hap. But why I have prayed typically
you don't take home right. I mean we do in real life we can
give it and send home but in for the sake of the board's we don't
write because the fact that it's short acting and the the
administration is a little bit different but these ones are
going to be ones that they will be taken at home.
If they are on an anticoagulant, how long do we stop?
Seven days. Prior to doing a procedure,
right? With this.
Education, what type of a question would this be on the
boards, right? What type of a question would
this be on the boards? Select select all that apply
right, select all that apply. Because it's education.
Check vitals every 15 minutes. Obtaining informed consent.
Ask him what three words about them being on medications.
Tell me more. Are you a native anticoagulant?
Tell me more. Okay cool.
Are you going to write it now? I'm going to tell them to stop
for seven days. When they come out post-op.
We are going to lay them. On the affected side.
We're going to lay them on the affected side.
Why do we do that? Good because ultimately we want
pressure on that side and we don't want it to bleed.
So the idea is stopped them on any anticoagulant so they don't
have the risk of bleeding. However, we're going into a
highly vascular organ, we're going to do a biopsy.
We're going to look for ash when we come out of it because well
it's post-op procedure regardless of it.
Any type of a procedure. We're always going to look for
ash, but in this situation, if I do a kidney biopsy, lay them on
that side. So if I do my right side, lay me
on that side, because I want to put pressure on you.
Because I put pressure on it, the idea is kind of like having
a bloody nose. What do you do?
You put pressure on it so you can.
Heel, you can clot. So lay them on the affected
side, lay them on the affected side.
Cool. So recap I started doing these
Recaps so I just kind of helps you see everything recap kidney
biopsy. How do you ask for the organ?
Post office, procedure always look trash.
Are we are always Above All Else, altered, mental status,
sepsis and Hemorrhage. Make sure you realize that the
vital signs in all of those are going to be different for sepsis
and Hemorrhage. Be able to do a logical
deduction. Critical thinking when they come
out, check, vitals Q. 15 minutes for the first hour, you will see
if they're hemorrhaging, you will see that decreased blood
pressure increased heart rate. Eight.
We give fluids, fluids fluids first.
You must obtain, informed consent.
Make sure you say that the therapeutic communication, tell
me more. If there aren't any type of
medication and to the anticoagulant.
Look, for those tricky ones, I Clopidogrel or aspirin and now
you're going to stop them. Seven days before they do a
biopsy and when they get done lay them, On the affected side
and monitor their vitals. Cool.