Podcast # 472: SMART Crystalloids

Author: Gretchen Hinson, MD

Educational Pearls:

  • In most healthcare settings, normal saline (NS) has become ubiquitous as an intravenous fluid despite some potential drawbacks
  • Compared to normal saline, a balanced crystalloid (either lactated Ringer’s or Plasma-Lyte) was associated with a lower composite endpoint of mortality, renal replacement therapy, and renal injury in SMART (Isotonic Solutions and Major Adverse Renal Events Trial)
  • Balanced crystalloids such as lactate Ringer’s may be preferable in more critically ill populations

References

Yau YW, Kuan WS. Choice of crystalloids in sepsis: a conundrum waiting to be solved. Ann Transl Med. 2016;4(6):121. doi:10.21037/atm.2016.02.09

Semler MW, Self WH, Wanderer JP, et al. Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med. 2018;378(9):829–839. doi:10.1056/NEJMoa1711584

Summarized by Will Dewispelaere, MS3 | Edited by Erik Verzemnieks, MD

Podcast # 420: CT Contrast and the Kidneys

Author: Don Stader, MD

Educational Pearls:

 

  • Recent meta-analysis has demonstrated that there is no significant risk for kidney injury from CT contrast
  • Most kidney injury  seen after contrast CTs were due to other underlying illnesses (sepsis, hypovolemia, etc.)
  • Older contrast agents likely did have nephrotoxic effects but this appears to be a thing of the past

 

References:

Aycock RD, Westafer LM, Boxen JL, Majlesi N, Schoenfeld EM, Bannuru RR. Acute Kidney Injury After Computed Tomography: A Meta-analysis. Ann Emerg Med. 2018 Jan;71(1):44-53.e4. doi: 10.1016/j.annemergmed.2017.06.041. Epub 2017 Aug 12. Review. PubMed PMID: 28811122.

Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD

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Podcast # 365: Renal Trigger Point Injections

Author: Erik Verzemnieks, MD

Educational Pearls:

  • Single study in Japan demonstrated possible effectiveness of renal colic trigger point
  • Patients had injection at the area of maximal tenderness on palpation of the flank
  • Compared to a muscle relaxer, injection of local anesthetic at the trigger point had faster time to pain relief and fewer rescue therapies

References

Iguchi, M et al. Randomized trial of trigger point injection for renal colic. International Journal of Urology. 2002. 9(9): 475-479