Generally I take care of very sick patients. That's kind of a no brainer, because even at their healthiest dialysis patient have many, many things wrong with them. Lets' put it this way-it's hard to impress NYC EMS workers, but dialysis patient's will do it almost every time.
But as I've been seeing patients I've been compiling a list of things that I've actually seen that I feel are VERY bad prognostic indicators. Most (if not all) have to do with lab results. So here are some of them, in no particular order:
"It's a bad sign when..."
- the PEEP on the ventilator is higher than the pt's a)platelets, b)hematocrit
- the white count and the hemoglobin are the same
- the white count and the hematocrit are the same
- the white count and the serum bicarb are the same
- the serum bicarb is higher than the platelet count
- the creatinine is higher than the serum bicarb
- the PT is higher than the PTT
- the INR is higher than the hematocrit
- the chart is heavier than the patient
Still working on more.