Emergency Room Patients

When A Dialysis Patient Presents To Your ER During Hurricane Rita Crisis – 09/23/05

Step 1: Ask the patient and/or family the following questions:

  • When did the patient receive his/her last dialysis treatment?
  • Did the patient stay on the dialysis machine for the entire treatment?
    • Or - was the last dialysis treatment shorter than normal?
  • Is he/she having any unusual symptoms – shortness of breath, chest pain, muscle twitching, changes in mental status, nausea/vomiting?

Step 2: Use Enclosed Triage Check List to assess patient’s clinical status:

  • Assess patient and check box(es) on Triage Check List if sign/symptom present.
  • Of particular concern are signs/symptoms of volume overload and/or hyperkalemia.
  • IMPORTANT: Draw a stat serum potassium if signs/symptoms of hyperkalemia are present (i.e., muscle twitching, cramping, cardiac irregularities or arrythmias, mental status changes).
  • If stat serum potassium shows hyperkalemia – administer Kayexalate ASAP.
  • If 5 or more boxes are checked on the Triage Check List, patient appears in need of emergency acute dialysis:
    • If your hospital provides acute dialysis: Contact acute dialysis unit or nursing supervisor to schedule emergency dialysis treatment.
    • If your hospital does NOT provide acute dialysis: Use hospital procedure for referring ER patient to a hospital that provides acute dialysis unit.

Step 3: If patient appears to be stable (according to Triage Check List) and does NOT have volume overload or hyperkalemia:

  • Tell patient/family that patient appears stable and does not need immediate dialysis.
  • Explain that, in emergency situations, most dialysis patients can miss ONE dialysis treatment (i.e., 3-5 days) without having any problems.
    • For example, many Hurricane Katrina kidney patients who were evacuated from Louisiana and Mississippi had to go without dialysis for 3-5 days.
    • Stress that it is ONLY "OK" to miss a treatment during emergency situations and that people who miss treatments on a regular basis are damaging their bodies.
  • Review the enclosed patient education materials with patient and family and send copy of education materials home with patient/family.
  • Instruct patient to call his/her regular dialysis clinic on Monday to schedule dialysis.
  • If patient is unable to contact his/her regular dialysis clinic on Monday, tell patient to call the ESRD Network of Texas at either 877-886-4435 (toll-free) or 972-503-3215. Network staff will be available to locate a dialysis unit for patients whose regular dialysis clinics are closed.
  • Stress to patient/family that if patient begins having shortness of breath, irregular heart beats, or muscle twitching or cramping between now and Monday – patient needs to go to the closest Emergency Room IMMEDIATELY to be re-evaluated.