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Until we know. 
So the first thing I'm going to 

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talk about is kidney biopsies. 
Kidney biopsies. 

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Well why are kidney biopsy so 
important. 

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So in general, If we do a kidney
biopsy, what is it? 

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Post-op post procedure. 
So if I'm looking at a patient 

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that's post-op, post procedure 
in general, forget kidney 

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biopsies, what's pneumonic that 
we're looking for good. 

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Ash. 
So kidneys liver any type of 

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biopsy. 
Lung, what are these organs 

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their highly vascular, right to 
highly vascular, which means 

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that there's a lot of room for 
error. 

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And, but in general post-op, 
post procedure. 

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We're looking at Ash because 
what's a mnemonic? 

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Do not let your patience turn. 
To ashes. 

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So Airway is above all else. 
Why? 

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If I'm going to get a biopsy? 
Well, maybe I have to sedate 

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them. 
I may even have to intubate 

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them. 
Nonetheless, I'm worried about 

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their Airway Airway Airway, and 
that is above all else. 

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Always number one, the 
remainder. 

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You find me one of those The 
next one is what altered mental 

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status. 
Well again we've given the 

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medication, we've sedated them. 
Maybe they come out and they are

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disoriented or whatever. 
All of a sudden with what just 

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happened. 
What just happened. 

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The next one is Sepsis. 
Well yeah, we just did an 

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invasive procedure. 
So of course there's going to be

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the ability to have sepsis 
because we may be able to 

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introduce bacteria fungi, 
violent reaction into their 

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bloodstream. 
Right? 

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And with sepsis what's my Triad?
Where is ninety? 

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Six point eight and below? 
Or 100.4 and above. 

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So you can hypothermia core you 
could be febrile, right? 

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What are the other two signs? 
Hypotension tachycardia. 

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But in sepsis you think the boys
are just gonna be like oh yeah 

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it's person is septic and they 
have 100.6 and their blood 

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pressure 60 over 30 and a heart 
rate is 127. 

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No. 
That would be too easy. 

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What are you going to say at the
incision site? 

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There's purulent discharge and 
they have a fever of 100.6. 

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Hmm. 
Logical deduction. 

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Critical thinking. 
Yeah. 

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Absolutely. 
Absolutely. 

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So you have to be able to figure
it out. 

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Hemorrhage. 
Highly, vascular organs kidney, 

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lung liver. 
If you do a biopsy and a highly 

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vascular. 
Do you think there's a risk for 

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causing Hemorrhage? 
Absolutely. 

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So now, if I do a kidney biopsy,
since we're doing renal, what 

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are the signs and symptoms of 
hemorrhage? 

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Hypotension and tachycardia. 
So this person is going to come 

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out. 
Do you think that they're just 

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going to say? 
Oh this person is hemorrhaging 

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and their blood pressure is 
down, the heart, rate is up, 

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know what they're going to say. 
Is this person is post-op. 

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Well, we're going to see first 
initial priority urgent. 

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Most concerning immediate report
to hcp and their post-op after a

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kidney biopsy and their blood 
pressure is 60 over 30. 

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Now, it's up to you to realize 
that this person is 

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hemorrhaging. 
It's up to you. 

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00:05:23,700 --> 00:05:30,100
To realize this person is 
hemorrhaging specifically with 

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kidney biopsies because it's a 
highly vascular organ. now, my 

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question is, On the boards. 
Remember, when I tell you, this 

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is how the board's would ask 
this question. 

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You better start that in your 
notes on the boards, this is how

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I would ask it, or this is how 
you're going to see a question. 

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Dka. 
Hemorrhage sepsis. 

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What do we do first? 
Fluids, fluids fluids with dka. 

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What are they going to try to 
trick you with insulin 

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potassium? 
Right? 

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00:06:20,700 --> 00:06:22,600
But no, you're not going to do 
that. 

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You're going to give them what 
fluids first. 

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Hemorrhaging, what are they 
going to try to trick you with? 

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Blood. 
Yeah. 

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Give them blood. 
And then, which sepsis what are 

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they going to try to trick you 
with? 

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Antibiotics good. 
So these are bored favorites 

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board favorites. 
So do not fall for those traits.

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Do not fall for those tricks 
because they are commonly asked 

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questions and they will be in 
the answer choices and you're 

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00:06:57,400 --> 00:07:00,000
going to look at them like, oh 
wait this person's had dka. 

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Maybe I should give them and to 
what's it called insulin first? 

83
00:07:06,400 --> 00:07:09,500
No, no, no, just think about 
real life. 

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00:07:09,500 --> 00:07:13,200
If somebody comes into the the 
ER, what are you gonna do first?

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You're gonna get intravenous 
access. 

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00:07:16,300 --> 00:07:20,700
And you're going to do what 
start fluids, always think about

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that. 
It's in general, and general DK,

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00:07:23,800 --> 00:07:27,000
sepsis and Hemorrhage. 
Always get fluids first do not 

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fall for that trick. 
With kidney biopsies. 

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Post-op how often are we going 
to check vitals for the first 

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00:07:38,800 --> 00:07:49,100
hour? 
Every 15 minutes. 15 minutes is 

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quite Regular, and it's 
frequent. so Q, 5:15 is very 

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00:08:00,400 --> 00:08:06,300
high frequency because again, 
why we're dealing with the 

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00:08:06,300 --> 00:08:10,200
highly vascular organ. 
We're dealing with a highly 

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00:08:10,200 --> 00:08:17,000
vascular organ. 
If? 

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00:08:18,600 --> 00:08:21,200
We are going to do a kidney 
biopsy. 

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00:08:21,200 --> 00:08:27,400
What must, what must we obtain? 
Good. 

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00:08:30,800 --> 00:08:36,700
Informed consent. 
Informed consent. if a patient 

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00:08:37,000 --> 00:08:46,000
is going to get a kidney biopsy 
and is on an anticoagulant, what

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00:08:46,000 --> 00:08:49,000
are some anticoagulants just 
run-of-the-mill? 

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00:08:51,300 --> 00:08:56,300
And sense which include aspirin.
How about your War friend? 

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Capito Grill. 
Good Clopidogrel is a good one 

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Clopidogrel. 
So, Warfarin Clopidogrel, 

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NSAIDs, which include aspirin. 
Yeah, your apixaban. 

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00:09:16,200 --> 00:09:23,700
All of these are going to be an 
indication operon I wouldn't say

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because why I'm not concerned 
about Heparin. 

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00:09:26,300 --> 00:09:29,200
I don't think it'll be there 
unless you're already 

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hospitalized and on hap. 
But why I have prayed typically 

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00:09:35,600 --> 00:09:40,500
you don't take home right. 
I mean we do in real life we can

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give it and send home but in for
the sake of the board's we don't

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00:09:44,400 --> 00:09:49,200
write because the fact that it's
short acting and the the 

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00:09:49,200 --> 00:09:53,600
administration is a little bit 
different but these ones are 

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going to be ones that they will 
be taken at home. 

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00:09:56,700 --> 00:10:00,400
If they are on an anticoagulant,
how long do we stop? 

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00:10:02,400 --> 00:10:13,100
Seven days. 
Prior to doing a procedure, 

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right? 
With this. 

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Education, what type of a 
question would this be on the 

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boards, right? 
What type of a question would 

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this be on the boards? 
Select select all that apply 

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right, select all that apply. 
Because it's education. 

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Check vitals every 15 minutes. 
Obtaining informed consent. 

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Ask him what three words about 
them being on medications. 

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Tell me more. 
Are you a native anticoagulant? 

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00:10:52,500 --> 00:10:53,800
Tell me more. 
Okay cool. 

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Are you going to write it now? 
I'm going to tell them to stop 

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for seven days. 
When they come out post-op. 

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We are going to lay them. 
On the affected side. 

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We're going to lay them on the 
affected side. 

129
00:11:25,300 --> 00:11:40,300
Why do we do that? 
Good because ultimately we want 

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pressure on that side and we 
don't want it to bleed. 

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So the idea is stopped them on 
any anticoagulant so they don't 

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have the risk of bleeding. 
However, we're going into a 

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highly vascular organ, we're 
going to do a biopsy. 

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We're going to look for ash when
we come out of it because well 

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00:12:01,500 --> 00:12:03,700
it's post-op procedure 
regardless of it. 

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00:12:03,800 --> 00:12:06,400
Any type of a procedure. 
We're always going to look for 

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00:12:06,400 --> 00:12:10,900
ash, but in this situation, if I
do a kidney biopsy, lay them on 

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that side. 
So if I do my right side, lay me

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00:12:13,000 --> 00:12:15,600
on that side, because I want to 
put pressure on you. 

140
00:12:17,300 --> 00:12:20,400
Because I put pressure on it, 
the idea is kind of like having 

141
00:12:20,400 --> 00:12:21,900
a bloody nose. 
What do you do? 

142
00:12:22,500 --> 00:12:24,300
You put pressure on it so you 
can. 

143
00:12:25,900 --> 00:12:30,800
Heel, you can clot. 
So lay them on the affected 

144
00:12:30,800 --> 00:12:32,900
side, lay them on the affected 
side. 

145
00:12:33,800 --> 00:12:38,200
Cool. 
So recap I started doing these 

146
00:12:38,200 --> 00:12:41,600
Recaps so I just kind of helps 
you see everything recap kidney 

147
00:12:41,600 --> 00:12:44,000
biopsy. 
How do you ask for the organ? 

148
00:12:45,900 --> 00:12:48,200
Post office, procedure always 
look trash. 

149
00:12:48,600 --> 00:12:51,300
Are we are always Above All 
Else, altered, mental status, 

150
00:12:51,300 --> 00:12:54,900
sepsis and Hemorrhage. 
Make sure you realize that the 

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00:12:54,900 --> 00:12:58,200
vital signs in all of those are 
going to be different for sepsis

152
00:12:58,200 --> 00:13:00,200
and Hemorrhage. 
Be able to do a logical 

153
00:13:00,200 --> 00:13:02,800
deduction. 
Critical thinking when they come

154
00:13:02,900 --> 00:13:09,400
out, check, vitals Q. 15 minutes
for the first hour, you will see

155
00:13:09,400 --> 00:13:12,800
if they're hemorrhaging, you 
will see that decreased blood 

156
00:13:12,800 --> 00:13:14,600
pressure increased heart rate. 
Eight. 

157
00:13:14,600 --> 00:13:17,200
We give fluids, fluids fluids 
first. 

158
00:13:17,900 --> 00:13:21,000
You must obtain, informed 
consent. 

159
00:13:21,100 --> 00:13:24,000
Make sure you say that the 
therapeutic communication, tell 

160
00:13:24,000 --> 00:13:25,900
me more. 
If there aren't any type of 

161
00:13:25,900 --> 00:13:27,800
medication and to the 
anticoagulant. 

162
00:13:28,100 --> 00:13:34,700
Look, for those tricky ones, I 
Clopidogrel or aspirin and now 

163
00:13:35,100 --> 00:13:40,100
you're going to stop them. 
Seven days before they do a 

164
00:13:40,100 --> 00:13:46,200
biopsy and when they get done 
lay them, On the affected side 

165
00:13:46,200 --> 00:13:49,100
and monitor their vitals. 
Cool.