Approach to Chest Pain During Dialysis
The development of chest pain during dialysis is of concern as it may be a harbinger of a potential catastrophe. The initial evaluation should begin with exclusion of immediately life-threatening causes. The dialysis vascular access can sometimes be contr
- PDF / 226,847 Bytes
- 8 Pages / 595.28 x 790.87 pts Page_size
- 100 Downloads / 233 Views
20
Chieh Suai Tan, Diego A. Covarrubias, and Steven Wu
20.1
Introduction
A patient who complains of chest pain during dialysis represents an immediate challenge. The symptoms may be of benign etiology, but occasionally, they may also be a harbinger of a potential catastrophe. Although mild chest pain or discomfort is reported to occur in 1–4 % of dialysis treatments [1], in light of the high incidence of cardiovascular events and sudden cardiac deaths in dialysis patients, any acute onset of chest pain in a patient on hemodialysis should be attended to promptly.
20.2
Initial Evaluation of Chest Pain
The initial evaluation should begin with the consideration of immediately life-threatening causes such as acute coronary syndrome (ACS), arrhythmia, aortic dissection, and pulmonary and air embolism. The dialysis should be terminated immediately and patient reclined to a recumbent position on the dialysis chair. Immediately check the venous bloodline; the presence of foaming is suggestive of air within the dialysis system, and port-wine appearance of blood is suggestive of hemolysis. C.S. Tan, MBBS • D.A. Covarrubias, MD Vascular Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA S. Wu, MD (*) Vascular Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA e-mail: [email protected]
If present, clamp the bloodlines and stop the pump to prevent the return of blood to the patient. If the patient is unstable, activation of an ambulance equipped with a defibrillator to an emergency department should be done immediately. Stabilization of such patients should begin immediately in the dialysis center. The dialysis needles may be left in situ after disconnection from the dialysis circuit. In the absence of peripheral venous access, in an emergency situation, the venous dialysis needle may be used for intravenous access. Dialysis catheter, if present, can also be used during resuscitation. Concurrently, placement of a cardiac monitor and supplemental oxygen should be done. Noninvasive monitoring of oxygen saturation should be set up. A 12-lead electrocardiogram and a blood sample for cardiac enzyme measurement should be obtained if possible. Patients who are thought to be experiencing an ACS, which includes ST-segment elevation myocardial infarction, non ST-segment elevation myocardial infarction, and unstable angina, should be given a 325 mg aspirin tablet. Sublingual nitroglycerin can be given for chest pain unless the patient has relatively low blood pressure. Once a life-threatening etiology has been excluded, attempts can be made t
Data Loading...
