Blood and Renal System Diseases PDF

Anatomy and Physiology of Blood: Blood functions as an organ, with key roles in transportation, regulation, and protection. Normal blood clotting requires platelets, clotting factors, and a functioning vascular system. Disorders of the Blood: Blood disorders include a range of coagulopathies, which are conditions affecting blood clotting. Causes of coagulopathies can be genetic, acquired, or due to medications. EMT Care for Coagulopathies: EMTs must identify patients with coagulopathies and provide appropriate care to stabilize them. Decision-making should focus on optimizing outcomes for these patients. Anemia and Sickle Cell Anemia: Different types of anemia have distinct characteristics. Sickle cell anemia's pathophysiology leads to specific disease presentations, requiring targeted EMT care. EMT Care for Sickle Cell Anemia: EMTs need to distinguish between sickle cell anemia and sickle cell trait. Key signs and symptoms of sickle cell emergencies include pain and hypoxia, with oxygen therapy being crucial. EMTs should consider ALS support based on the patient's condition. Anatomy and Physiology of the Kidneys: The kidneys maintain blood balance by filtering waste and regulating hydration. Each renal structure has a specific function in this process. Diseases of the Renal System: Renal diseases include urinary tract infections, kidney stones, and renal failure. Acute renal failure has sudden causes, while chronic renal failure develops over time. Hemodialysis and peritoneal dialysis are treatments for renal failure. EMT Care for End-Stage Renal Disease: Complications of end-stage renal disease and dialysis require careful EMT management. Missing dialysis can have severe consequences, and EMTs must be prepared to handle various dialysis-related complications. Special considerations are needed for kidney transplant patients. Key Terms The human body’s health relies on the seamless functioning of multiple organ systems. EMTs often focus on acute emergencies related to the cardiovascular and respiratory systems. This chapter covers diseases and problems related to the hematologic (blood) and renal (kidney) systems. Hematology: Medical specialty focused on blood disorders. Nephrology: Medical specialty focused on kidney diseases. Many medical conditions can arise from diseases of the hematologic and renal systems. Certain patients with specific diseases in these systems are more likely to require EMS services. The Hematologic System Blood is an organ system with critical functions including clotting, oxygen delivery, and waste removal. Blood consists of solid components (red blood cells, white blood cells, and platelets) and plasma. Red Blood Cells (RBCs): Make up the majority of blood cells and give blood its red color. Contain hemoglobin, which binds to oxygen for delivery to cells. RBC count is measured by a hemoglobin count. White Blood Cells (WBCs): Crucial for immune response and infection control. Different types include neutrophils (fight bacterial infections) and eosinophils (associated with allergies). Platelets: Fragments of larger cells, essential for clot formation. Aggregate rapidly to stop bleeding but can cause harmful clots in certain conditions, such as coronary artery plaque rupture. Aspirin is used to prevent platelet aggregation during heart attacks. Plasma: Liquid component of blood, suspending cells and platelets. Contains dissolved nutrients and crucial proteins like clotting factors. Blood Clotting When bleeding occurs, the body must activate its clotting system to prevent excessive blood loss. Platelets and clotting factors are the two major components responsible for clotting. Platelets provide the body's most rapid and initial response by clumping together to stop bleeding. Clotting factors are proteins produced in the liver and released into the bloodstream in inactive forms. When blood vessel damage occurs, clotting factors are activated to initiate clotting. Activated clotting factors form clots through a series of steps known as clotting cascades. Clotting cascades result in the formation of stable clots, which replace the initial platelet clumps to effectively control bleeding. Coagulopathies Coagulopathy is defined as abnormal blood clotting, which can result in either excessive clotting or, more commonly for EMTs, slow clotting leading to uncontrolled bleeding. Slow clotting can be due to issues with the clotting cascade, insufficient or dysfunctional platelets, or a combination of these factors. Medications are the most common cause of coagulopathy encountered by EMTs. These medications are often prescribed to slow clotting in patients with certain medical conditions. Liver disease can lead to coagulopathy because the liver produces clotting factors. Advanced liver disease, such as cirrhosis, can result in inadequate clotting factor production. Inherited genetic disorders can also cause coagulopathies. Examples include: Hemophilia: Prevents the production of certain clotting factors. Von Willebrand’s disease: The most common inherited blood disorder, where platelets are functionally defective despite being present in normal numbers. Medical conditions that benefit from reduced clotting include those at risk for heart attacks, strokes, or abnormal cardiac rhythms like atrial fibrillation. Common blood-thinning medications include: Coumadin® (warfarin) Pradaxa® (dabigatran) Eliquis® (apixaban) Xarelto® (rivaroxaban) Lovenox® (enoxaparin) Aspirin and Plavix® (clopidogrel), which inhibit platelet aggregation. Patients on these medications are at higher risk for life-threatening bleeding when injured, leading to potential upgrades to trauma center transport even for minor injuries, following local protocols. Identifying Patients with Coagulopathies A thorough patient history is crucial for assessing patients with suspected clotting disorders. Identifying patients at risk for abnormal bleeding involves reviewing their past medical history and current medications. Patients with atrial fibrillation often take blood thinners, which increases their risk of bleeding. EMTs should prioritize obtaining a SAMPLE history, especially for trauma patients. It is essential to ask trauma patients if they are on any blood thinners during the assessment. Identifying Patients with Coagulopathies A thorough patient history is crucial for assessing patients with suspected clotting disorders. Identifying patients at risk for abnormal bleeding involves reviewing their past medical history and current medications. Patients with atrial fibrillation often take blood thinners, which increases their risk of bleeding. EMTs should prioritize obtaining a SAMPLE history, especially for trauma patients. It is essential to ask trauma patients if they are on any blood thinners during the assessment. Anemia Anemia is a deficiency in the normal number of red blood cells (low hemoglobin count). Acute anemia can result from trauma or sudden massive bleeding from the gastrointestinal tract. Symptoms include rapid pulse rate, cool and clammy skin, and eventual hypotension. Chronic anemia develops over time due to conditions like recurrent heavy menstrual periods, slow gastrointestinal blood loss, or diseases affecting bone marrow or hemoglobin structure. Symptoms include pallor, fatigue, and shortness of breath with exertion. Signs of shock appear only after a prolonged period. Assessment for chronic anemia can be done by examining the color of the patient's conjunctiva on the lower eyelid. Anemic patients have very pale conjunctiva compared to the red/pink color in normal patients. Sickle Cell Disease Sickle cell disease (SCD) is an inherited genetic defect affecting hemoglobin, leading to abnormal red blood cell (RBC) structure. SCD predominantly affects individuals of African descent, with an incidence of about 1 in 365 African American births. The abnormal hemoglobin in SCD causes RBCs to lose their normal doughnut shape and compressibility, resulting in sickle-shaped cells. These sickle-shaped RBCs have a shorter lifespan in circulation, leading to chronic anemia known as sickle cell anemia (SCA). Normal RBCs are flexible and can pass through small capillaries to deliver oxygen, whereas sickle-shaped RBCs cannot, causing various complications. Figure 28-3 Scanning electron photomicrograph of normal red blood cells contrasted with a sickle cell. Destruction of the spleen: Blockages by abnormal RBCs lead to spleen damage, increasing the risk of severe infections. Sickle cell pain crisis: Severe pain in arms, legs, chest, and abdomen due to sludging of sickled RBCs in capillaries. Acute chest syndrome: Characterized by shortness of breath and chest pain due to blocked blood vessels in the lungs, leading to hypoxia. Priapism: Painful, prolonged erections in males caused by blocked blood drainage from the penis. Stroke: Occurs when sludging RBCs block blood vessels supplying the brain. Jaundice: Yellowish pigmentation of body tissues due to the liver being overwhelmed by the breakdown of RBCs. Life span: Patients with SCA have a shorter life span and may become dependent on narcotic pain medications due to persistent painful crises. Sickle cell trait: Individuals with the trait carry the gene but do not suffer from the disease or its complications and have normal life spans. Table 28-1 External Manifestations and Internal SCD Complications The spleen may become non-functional due to damage from sickled red blood cells, leading to increased susceptibility to infections. Vaso-occlusive crisis occurs when sickled red blood cells block microcirculation, causing hypoxia and severe pain, often in bones, joints, abdomen, and soft tissues. Acute chest syndrome results from vaso-occlusive crisis in the lungs, leading to difficulty breathing, chest pain, cough, and fever. Priapism, a prolonged and painful erection, occurs when sickled red blood cells block blood flow out of the corpus spongiosum. Sickle cell patients are at higher risk for ischemic stroke, potentially due to sickled cells affecting brain microcirculation or larger arterial vessels. Jaundice, characterized by yellowed skin and eye whites, occurs when the liver is overwhelmed by the breakdown of red blood cells, impairing normal liver function. Table 28-1 External Manifestations and Internal SCD Complications The spleen can be damaged by sickled red blood cells, leading to loss of immune function and increased susceptibility to infections. Vaso-occlusive crisis occurs when sickled red blood cells block microcirculation, causing hypoxia and severe pain in bones, joints, abdomen, and soft tissues. Acute chest syndrome results from vaso-occlusive crisis in the lungs, leading to difficulty breathing, chest pain, cough, and fever. Priapism, a prolonged and painful erection, occurs when sickled red blood cells block blood flow out of the corpus spongiosum. Sickle cell patients are at higher risk for ischemic stroke, potentially due to sickled cells affecting brain microcirculation or larger arterial vessels. Jaundice, characterized by yellowed skin and eye whites, occurs when the liver is overwhelmed by the breakdown of red blood cells, impairing its function. The Renal System The renal system consists of two kidneys, two ureters, a bladder, and a single urethra. Kidneys filter blood to produce urine. Ureters transport urine from the kidneys to the bladder. The bladder stores urine until it is excreted. The urethra carries urine from the bladder to the outside of the body. Figure 28-4 The renal system. The kidneys filter blood to remove waste products, excessive salts, and fluids. During dehydration, the kidneys help retain necessary fluids. These functions make the kidneys essential for life. Urinary Tract Infections Urinary tract infections (UTIs) are common in the renal and urinary system. UTIs are caused by bacteria and typically affect the bladder, leading to painful and frequent urination. If untreated, a bladder infection can spread to the kidney, resulting in pyelonephritis. Pyelonephritis symptoms include unilateral flank pain and more severe illness compared to uncomplicated bladder infections. UTIs can become serious and life-threatening if bacteria enter the bloodstream, particularly in elderly patients. Kidney Stones Kidney stones are a common and painful condition related to the renal system. They are usually composed of calcium and form within the kidney. Kidney stones typically cause no symptoms if they remain in the kidney. Severe unilateral flank pain that radiates to the groin occurs when a stone descends from the kidney and becomes lodged in the ureter. Associated symptoms of kidney stone pain include nausea and vomiting. Patients with Urinary Catheters Patients may lose the ability to urinate normally due to obstructions (e.g., tumors, enlarged prostate) or neurologic disorders. Urinary catheters are used to drain urine in these patients. The most common placement for a urinary catheter is through the urethra. Some patients use long-term catheters, while others use self-catheters each time they urinate. In some cases, catheters are placed directly through the skin into the kidney or bladder by a urologist or surgeon. Common complications of urinary catheters include acute and chronic urinary tract infections and local trauma at the insertion site. Renal Failure Renal failure is the most serious kidney disease, characterized by the kidneys' inability to filter blood and remove toxins and excess fluid. Acute renal failure can result from shock, toxic ingestions, and other causes. It may be reversible if the underlying cause is quickly identified and treated, such as severe dehydration treated with intravenous fluids. Chronic renal failure develops gradually, often due to long-term conditions like diabetes and uncontrolled high blood pressure. Inherited diseases like polycystic kidney disease can also cause chronic renal failure. End-stage renal disease (ESRD) occurs when kidneys can no longer sustain life due to irreversible renal failure. Patients with ESRD typically require dialysis to survive. Dialysis is a medical process that removes toxins and excess fluid from the body using an external system. There are two main types: hemodialysis and peritoneal dialysis. Hemodialysis is the most common form, with over 90% of ESRD patients receiving it in specialized outpatient centers. Treatments usually occur three times a week, lasting 3-4 hours each. Peritoneal dialysis is less common, with only 8% of U.S. dialysis patients using it or performing hemodialysis at home. The need for medical transport to dialysis centers has led to frequent interactions between EMTs and ESRD patients. Patients with Urinary Catheters Patients may lose the ability to urinate normally due to obstructions (e.g., tumors, enlarged prostate) or neurologic disorders. Urinary catheters are used to drain urine in these patients. The most common placement for a urinary catheter is through the urethra. Some patients use long-term catheters, while others use self-catheters each time they urinate. In some cases, catheters are placed directly through the skin into the kidney or bladder by a urologist or surgeon. Common complications of urinary catheters include acute and chronic urinary tract infections and local trauma at the insertion site. How a dialysis machine works Renal failure is the most serious kidney disease, characterized by the kidneys' inability to filter blood and remove toxins and excess fluid. Acute renal failure can result from shock, toxic ingestions, and other causes. It may be reversible if the underlying cause is quickly identified and treated, such as severe dehydration treated with intravenous fluids. Chronic renal failure develops gradually, often due to long-term conditions like diabetes and uncontrolled high blood pressure. Inherited diseases like polycystic kidney disease can also cause chronic renal failure. End-stage renal disease (ESRD) occurs when kidneys can no longer sustain life by providing adequate filtration and fluid balance. Patients with ESRD typically require dialysis to survive. Dialysis is a medical process that removes toxins and excess fluid from the body using an external system. There are two main types: hemodialysis and peritoneal dialysis. Hemodialysis is the most common form of dialysis, with over 90% of ESRD patients receiving it in specialized outpatient centers. Treatments usually occur three times a week, lasting 3 to 4 hours each. Peritoneal dialysis is less common, with only 8% of U.S. dialysis patients using it or performing hemodialysis at home. The need for medical transport to dialysis centers has created frequent interactions between EMTs and ESRD patients. Hemodialysis In hemodialysis (HD), a patient is connected to a dialysis machine that filters blood to remove toxins and excess fluid. The connection to the dialysis machine is made through two large catheters. One catheter allows blood to flow out of the body into the dialysis machine. The other catheter returns the filtered blood back to the body. This process creates a continuous circuit of blood removal, filtration, and return over several hours. Figure 28-6 How hemodialysis works. Hemodialysis (HD) requires large blood flow: Patients with End-Stage Renal Disease (ESRD) on HD need specialized access to their blood circulation. Types of access: Two-port catheter: Inserted into one of the major veins of the torso. Arteriovenous (A-V) fistula: Surgically created connection between an artery and a vein in an extremity. Characteristics of A-V fistula: Turbulent flow: The connection between the artery and vein creates turbulent blood flow. Thrill: A properly functioning A-V fistula will have a characteristic vibration, known as a thrill, which can be felt when gently palpated. Patient care considerations: ESRD patients are protective of their fistulas and prefer blood pressure measurements to be taken from another extremity to avoid compromising the fistula. Peritoneal Dialysis Patients with ESRD often manage their condition with peritoneal dialysis (PD) at home. PD is a slower process than hemodialysis (HD) and typically requires multiple daily treatments. Many patients prefer PD over HD because it allows for home treatment. Outside the United States and Canada, PD is the most common form of dialysis. PD utilizes the large surface area of the peritoneal cavity to remove toxins and excess fluid from the body. ESRD patients on PD have a permanent catheter implanted through their abdominal wall into the peritoneal cavity. Several liters of a specially formulated dialysis solution are introduced into the abdominal cavity, left for several hours to absorb waste and excess fluid, and then drained and discarded. The PD fluid setup resembles a large IV bag and tubing. Each cycle of filling and draining the peritoneal cavity is called an exchange. Figure 28-9 Peritoneal dialysis catheter. There are two types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD) and continuous cycler-assisted peritoneal dialysis (CCPD). CAPD involves leaving dialysis fluid in the peritoneal cavity for 4–6 hours by clamping the catheter. The patient repeats this exchange several times a day using a simple gravity exchange process. The dialysis fluid is run into the peritoneal cavity by elevating the bag above the abdominal catheter and drained out by lowering the bag below the abdomen. CCPD uses the same type of peritoneal catheter as CAPD but employs a machine to fill and empty the abdominal cavity with dialysis fluid 3–5 times during the night while the person sleeps. In the morning, the last fill remains in the abdomen with a dwell time that lasts the entire day. Figure 28-9 Peritoneal dialysis catheter. Types of Peritoneal Dialysis: There are two main types: continuous ambulatory peritoneal dialysis (CAPD) and continuous cycler-assisted peritoneal dialysis (CCPD). Continuous Ambulatory Peritoneal Dialysis (CAPD): Most common type of peritoneal dialysis. Fluid is left in the peritoneal cavity for 4–6 hours by clamping the catheter. The patient repeats the exchange several times a day. Utilizes a simple gravity exchange process: the dialysis fluid bag is elevated to fill the cavity and lowered to drain it. Continuous Cycler-Assisted Peritoneal Dialysis (CCPD): Uses the same type of peritoneal catheter as CAPD. A machine fills and empties the abdominal cavity with dialysis fluid 3–5 times during the night while the patient sleeps. In the morning, the last fill remains in the abdomen for the entire day. Medical Emergencies with End-Stage Renal Disease Medical emergencies in ESRD patients can be categorized into two main groups: those due to loss of normal kidney function and those due to complications from dialysis treatments. ESRD patients often have other serious underlying conditions like diabetes and high blood pressure, which can also lead to medical emergencies independent of renal failure. Complications of ESRD Complications of ESRD: The most serious complications occur when patients miss dialysis. Common reasons for missed dialysis: Bad weather, illness, and poor compliance. Symptoms of missed dialysis: Shortness of breath due to fluid buildup in the lungs. Fluid accumulation in the ankles, hands, and face. Electrolyte imbalance: Patients cannot balance and clear excess electrolytes and toxins. This can lead to electrical disturbances of the heart (dysrhythmias). Danger of elevated potassium levels: Elevated potassium levels are particularly dangerous. Can result in patient death from dysrhythmias. Complications of Dialysis Hemodialysis Complications: Frequent access to large blood vessels can lead to several issues. Bleeding from the A-V fistula site when needles are removed. Clotting and loss of function of the A-V fistula, making it hard to the touch and losing the normal thrill on palpation. Bacterial infection of the blood due to contamination at the A-V fistula or dialysis catheter site. Peritoneal Dialysis Complications: The most common serious complication is acute peritonitis, a bacterial infection within the peritoneal cavity. Symptoms of peritonitis include abdominal pain, fever, and cloudy dialysis fluid, which resembles chicken broth in color and turbidity. Additional Risks: Dialysis patients often have underlying conditions such as diabetes and high blood pressure, increasing their risk for other medical emergencies. Kidney Transplant Patients Kidneys are the most commonly transplanted organs. Renal transplants are performed for patients with end-stage renal disease (ESRD) to provide a normally functioning kidney and eliminate the need for dialysis. Approximately 21,000 kidney transplants are performed annually in the United States. A renal transplant involves placing a single healthy kidney in the lower abdomen of the patient and connecting it to the blood supply and ureter. Post-transplant, patients must take immunosuppressive drugs for life to prevent organ rejection. Immunosuppressive drugs increase the risk of serious infections, including sepsis. Chapter Review Blood delivers oxygen to cells, removes carbon dioxide, and controls bleeding through clotting. Blood components include red blood cells, white blood cells, platelets, and plasma. Anemia: A deficiency of red blood cells in circulation. Sickle cell disease: An inherited condition causing red blood cells to become sickle-shaped, leading to blockages in capillaries and chronic anemia. The renal system includes the kidneys, ureters, bladder, and urethra. Kidneys: Filter blood to remove waste and maintain water balance. Renal system issues include infections, kidney stones, and renal failure. Renal failure: Kidneys cannot filter waste or balance fluids and electrolytes. Dialysis: Removes excess fluid and electrolytes; can be hemodialysis (performed at centers) or peritoneal dialysis (done at home). Major complications in end-stage renal disease can arise from missed dialysis, infections, or bleeding from hemodialysis access sites. Chapter Glossary Anemia: Deficiency in the number of red blood cells in circulation. Coagulopathy: Loss of the normal ability to form a blood clot, leading to internal or external bleeding. Continuous Ambulatory Peritoneal Dialysis (CAPD): A gravity exchange process for peritoneal dialysis where dialysis fluid is raised above the abdominal catheter to fill the abdominal cavity and lowered to drain the fluid out. Continuous Cycler-Assisted Peritoneal Dialysis (CCPD): A mechanical process for peritoneal dialysis using a machine to fill and empty the abdominal cavity of dialysis solution. Dialysis: The process of removing toxins and excess fluid from the body using a medical system independent of the kidneys. End-Stage Renal Disease (ESRD): Irreversible renal failure where the kidneys can no longer provide adequate filtration and fluid balance, usually requiring dialysis for survival. Exchange: One cycle of filling and draining the peritoneal cavity in peritoneal dialysis. Peritonitis: Bacterial infection within the peritoneal cavity. Pyelonephritis: An infection that starts in the urinary tract and ascends up the ureter into the kidney. Renal Failure: Loss of the kidneys' ability to filter blood and remove toxins and excess fluid from the body. Sickle Cell Anemia (SCA): An inherited disease with a genetic defect in hemoglobin causing abnormal red blood cell structure. Sickle Cell Disease (SCD): An inherited disease where a genetic defect in hemoglobin results in abnormal red blood cell structure. Thrill: A vibration felt on gentle palpation, typically occurring within an arterial-venous fistula. Urinary Catheter: A drainage tube placed into the urinary system to allow urine to flow out of the body. Thinking and Linking Missing dialysis can lead to fluid buildup, causing signs and symptoms similar to congestive heart failure, such as shortness of breath, swelling in the legs and ankles, and fatigue. Palpitations in a patient who has missed several dialysis treatments can be due to electrolyte imbalances, particularly high potassium levels, which affect the heart's rhythm. Critical Thinking Exercises Renal diseases and dialysis: Missing a dialysis session can lead to severe complications, including difficulty breathing and a feeling of impending doom due to fluid overload and electrolyte imbalances. Sickle cell anemia: Patients with a history of sickle cell crisis can experience severe pain due to vaso-occlusive episodes. This pain is genuine and can be debilitating, requiring appropriate pain management and medical intervention. Pathophysiology to Practice Sickle cell disease increases the likelihood of a stroke due to the abnormal shape of red blood cells, which can block blood flow to the brain. Patients with sickle cell disease are prone to severe, recurring infections because the disease can damage the spleen, an organ crucial for fighting infections.

Blood and Renal System Diseases PDF

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