Milestones in Critical Care

[Old_School]

The story goes that a group of Nephroloqists got together one day and decided that they were tired of being "dialysis doctors". They wanted to be more pro-active and preserve kidney function. They were tired of being called in on the third chapter of the patient's story by the surgeons and the cardiologists, only to find that the reversable ATN had progressed to ARF. They were tired of eventually having to assume the long term care of these patients on chronic HD for something that was totally preventable. They were "kidney doctors", by god; not "dialysis doctors".

At about the same time, I noticed this trend of liberal use of diuretics and massive quantities of fluid by the afformentioned "non-kidney doctors". It was heart breaking to see that daily rise of BUN/Cr and the loss of urine flow. I literally hated to call the "non-kidney doctors" because of the orders that I would be obliged to follow. When I got wind of what the nephrologists were thinking, I climbed on board that train real quick. At the first sign that a patient's kidney's were failing, I was on the phone with the "non-kidney doctors" urging them to call the nephrology consult. This was my mission. They resisted at first, but they eventually tired of my persistance and allowed the consult. I would then follow up by always clearing the "non-kindney doctor's" fluid and diuretic orders through the nephrologist. Imagine how that went over. I also urged my fellow nurses to do likewise.

Over the last twenty years, I can't even imagine how many kidneys we've saved. There are plenty of patients that truly have no alternative than dialysis. To subject someone to HD when a little care and close monitoring can prevent a lifetime of hell is inconceivable. Nephrologist are now a fixture in our ICU. Their input is always greatly appreciated. Have you hugged your nephrologist today?

O_S