Genitourinary and Renal Emergencies Study Guide

Unit Summary

  • Completion of Chapter 22 and related assignments enables students to:
    • Describe anatomy and physiology of male and female urinary systems.
    • Conduct primary and secondary assessments for renal and genitourinary emergencies.
    • Identify physical exam components and obtain thorough patient histories.
    • Understand pathophysiology of common renal and genitourinary diseases, including those of the male genital tract.
    • Discuss renal dialysis types, purposes, complications, and prehospital interventions.

National EMS Education Standard Competencies

  • Medicine:
    • Integrates assessment findings with principles of epidemiology and pathophysiology for field impressions and treatment plans.
  • Genitourinary/Renal:
    • Assess blood pressure in hemodialysis patients.
    • Recognize complications related to renal dialysis and urinary catheter management.
    • Understand anatomy, physiology, epidemiology, and management of kidney stones, acute renal failure, chronic renal failure, and related conditions.

Knowledge Objectives

  1. Anatomy & Physiology
    • Understand kidneys, ureters, urinary bladder, and urethra.
  2. Primary & Secondary Assessment
    • Explain management for patients with renal/genitourinary emergencies.
  3. Transport Decisions
    • Specify factors influencing transport for renal/genitourinary patients.
  4. History Taking
    • Discuss essential questions for obtaining patient history.
  5. Documentation
    • Specify best practices for documenting renal/genitourinary emergencies.
  6. Pain Types
    • Compare visceral pain with referred pain.
  7. Diagnosis Contribution
    • Explain how visceral/referred pain aids field diagnosis.
  8. Physical Exam Components
    • Identify key components for renal/genitourinary emergencies.
  9. Effective Treatment Plans
    • Name components of an effective treatment plan.
  10. Common Diseases Management
    • Outline management of UTIs, kidney stones, acute kidney injury, among others.
  11. Dialysis Purpose & Types
    • Discuss renal dialysis types and their purposes.
  12. Dialysis Complications
    • Identify potential complications and related prehospital interventions.
  13. Male Genital Tract Conditions
    • Discuss management of various male genital tract conditions.

Readings and Preparation

  • Review materials including Chapter 22 and related articles:
    • "Renal Failure & Dialysis Patients: What the EMS Provider Should Know".
    • "Patient Presents with Renal Condition".
    • "Acute Kidney Injury Assessment and Treatment".
  • Consider reading articles discussing dialysis patients and emergency preparedness.

Support Materials

  • Lectures:
    • PowerPoint presentations on related topics.
  • Field Trip Considerations:
    • Visit local dialysis center for practical exposure to equipment and procedures.
  • Patient Care Protocols:
    • Contact local EMS organizations to share treatment protocols.
  • Scenario Cards:
    • Prepare scenario cards for group activities during lessons.

Enhancements

  • Engage with local dialysis centers and invite professionals to discuss home dialysis challenges.
  • Address cultural sensitivity challenges regarding male genitourinary emergencies.

Teaching Tips

  • Prepare visual aids for devices related to renal/genitourinary issues.
  • Allow small group discussions for sensitive topics.

Unit Activities

Writing Activities

  • Research and summarize challenges associated with medical care for patients with ESRD.

Presentations

  • Investigate local statistics on dialysis patients and present findings.

Group Activities

  • Utilize scenario cards to practice critical thinking in real-life scenarios.

Pre-Lecture Activities

  • You Are The Paramedic:
    • Read scenario and respond to discussion questions in groups, applying critical thinking skills.

Introduction

Urinary System Functions

  • Filters blood, removes metabolic wastes, manages electrolytes, maintains acid-base balance, regulates fluid volume and blood pressure.
  • Kidney Failure Prevalence:
    • 661,000 affected in the US, with 468,000 requiring dialysis and 193,000 living with functioning transplants.
  • Nephrolithiasis:
    • Most common acute renal disease affecting 11% of men and 6% of women.

Anatomy & Physiology Review

  • The urinary system: consists of kidneys, ureters, urinary bladder, and urethra.
    • Urethra is shorter in females, increasing infection risk.
Kidneys Internal Anatomy
  • Divided into cortex, medulla, and pelvis.
    • Nephrons:
    • Structural and functional units.
    • Composed of: Glomerulus, Bowman capsule, Proximal convoluted tubule, Loop of Henle, Distal convoluted tubule.
Male Genital System
  • Shares urethra for urine, semen, and secretions.

Patient Assessment

  • Follow standard assessment protocols, including scene size-up, primary survey, and secondary assessment.

Scene Size-Up

  • Take standard precautions.
  • Be aware of overlapping genitourinary and abdominal conditions.

Primary Survey

  1. General impression and life-threatening condition check.
  2. Assess mental status and ABCs.
  3. Vital Signs:
    • Circulation — skin color, heart rate, blood pressure assessment.
  4. Determine need for urgent transport considering uremia, hyperkalemia, or testicular torsion.

History Taking

  • Collect thorough history using SAMPLE mnemonic:
    • Pain:
    • Understand differences between visceral and referred pain.

Secondary Assessment

  • Conduct a detailed physical exam capable of identifying flank tenderness or signs of infection.
  • Monitor vital signs at intervals.

Reassessment

  • Frequent reassessment required for patients with urologic emergencies.
  • Note the link between abnormal vital signs and patient history.

Emergency Medical Care

Pain Management

  • Allow patients to assume a comfortable position.
  • Administer IV fluids and antiemetics if nausea or severe pain occurs.

Pathophysiology, Assessment, and Management of Specific Emergencies

Urinary Tract Infections (UTIs)

  • Common in females; may lead to pyelonephritis if untreated.
  • Symptoms:
    • Painful urination, frequent urges, flank tenderness, and systemic symptoms in severe cases.

Urinary Catheters

  • Understand catheterization procedures and concerns for transporting catheterized patients.

Urinary Obstruction and Incontinence

  • Assess for urinary retention and conditions causing it.

Kidney Stones (Renal Calculi)

  • Describe types and symptoms associated with kidney stones, focusing on pain and management.

Acute Kidney Injury (AKI)

  • Understand definitions, causes (prerenal, intrarenal, postrenal), and risk factors associated with AKI.

Chronic Kidney Disease (CKD)

  • Discuss progressive diagnosis and management considerations.

End-Stage Renal Disease (ESRD)

  • Recognize patients' presentation and management strategies required for them.