Table 1.

Acute dialysis orders objective structured clinical examination description

Question Scenario and Topic (1)Total PointsPassing Score (%)Evidence-Based/Standard-of-Care Questions
1. Order acute CRRT in a septic, acidemic, hypoxic, coagulopathic, hypotensive, oncology patient.2015 (75)A. Correct for hypalbuminemia when calculating anion gap.
B. Obtain at least 20 ml/kg per hour effluent.
C. (2017 administration only) Estimate clearance using effluent rate.
2. Order maintenance HD initiation for a uremic patient with volume overload and an AV fistulaa2117 (81)A. Avoid low K dialysate (<3 meq/L) in those with normal serum K, unless only a low K dialysate is available.
B. Identify uremic encephalopathy (mild to severe) and serositis (pleural, pericardial) as urgent/absolute indications for dialysis.
3. Manage acute, life-threatening hyperkalemia and volume overload in anuric patient with ESKD on maintenance HDb1714 (82)A. Bicarbonate therapy not indicated in acute hyperkalemia in volume-overloaded patient with ESKD without acidosis. Negligible effect.
B. Repeat serum K at 2–4 h and at 6 h after dialysis, due to rebound.
Overall5846 (79)NA
  • CRRT, continuous RRT; HD, hemodialysis; AV, arteriovenous; K, potassium; NA, not applicable.

  • a One item could yield one bonus point (use of smaller gauge dialysis needles in a new AV fistula in scenario 2).

  • b Points could be lost on this question if intravenous sodium bicarbonate was administered (−1 point), if epinephrine was administered (−1 point), or if intravenous Lasix was administered in this anuric patient with ESKD (−1 point).