Great video Another Clinical cause that we face a lot with surgical patients is constipation, diverticulosis or obstruction. Knowing the last time the patient passed BM can help in our clinical judgment. On multiple occasions, I found patients' urine output improves after they pass.
Great job. You would be amazed how many times low uop and/or slow rise in crt is from retention. Also just bc renal ultrasound doesn't show obstruction doesn't necessarily mean there is not retention, which is common misconception. Once corrected all resolves, work in nephro and happens more than you think.
Thank you, doc, for these types of videos, with common pitfalls mentioned and to be able to see your ratinole from a practial point of view. Btw, I love the drawn cover images.
Thanks Dr Strong I am ICU Rapid Response Team Charge Nurse in UAE I am the first response person to the scene then based on my assessment further escalation to ICU initiating Your Videos are really worth full, helped me many times, Thank you Is there any professional certification particular for RRT that we can attend from UAE
Hi, I would like to suggest you to improve your videos with en subtitles for the ones who don't have a perfect listening (especially considered the using of technical terms)
Not necessarily. Sometimes when the bladder is full enough to lead to high intrabladder pressure, that pressure can be high enough to "squeeze" some urine through a lower obstruction until the pressure is lowered. So patients end up with incomplete voiding. In an extreme case of this, patients eventually develop something called overflow incontinence in which the kidney's continuous production of urine adds enough to the bladder pressure that patients can leak urine through the obstruction throughout the day.
I have that output daily and now restricting water as I am bloating up despite quite a low calorie intake. I can't afford to gain weight as ny joints don't take it and won't even eat dinner as there's fluid in it. I think there's something wrong with my kidneys.
PVR isn't accurate in a patient that is inconvenient. I'm a nurse and the number of docs that order a PVR and expect it to be accurate is crazy. It's an unfortunate circumstance but there's little correlation to a void and a bladder scan. Most patients that are inconvenient are not able to tell when they urinated and it might be as long as two hours from the time they went. A q4 or q6 bladder scan and a cath above x amount is a better way to go.
I am assuming you mean "incontinent" rather than "inconvenient"... If the patient is incontinent and not able to tell when they last urinated, you should still ask them to spontaneously void. If they can't, whatever the bladder volume is at that time is still their PVR, incontinence notwithstanding. I agree about common overestimation of the scanner's accuracy. Despite the machine reporting 3 significant figures (i.e. to the individual mililiter), I wouldn't consider them to be any more accurate than within 100mL. (e.g. a scan result of 287mL one day and 253mL the next is not an improvement). I generally approach bladder scan results as trichotomous: high --> put foley in; low --> leave foley out; in the middle --> discuss pros and cons of foley with patient.
@Strong Medicine Yes. Incontinent. That's what working midnight shift gets ya. What is your take on patients who are scanning low, say around 100, but always seem wet. Again, they aren't able to say when they voided. Is the constant leakage paired with a rather low scan considered appropriate bladder emptying, or would a Foley be a better option along with exploring medications?
