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1. Summarize the history.
 
 
2. Based on the dialysis record, why was dialysis terminated early?
 
 
3. Review the records and decide how much time elapsed between the end of dialysis and the time the paramedics were called? What explains this? Is there a concern?
 
 
4. Who’s responsibility is it to call 911 in a dialysis center or any outpatient or medical facility? What if the patient does not want 911 called? What is the right decision?
 
 
5. What is the difference between the initial Clinic Notes and the revised Clinic Notes from the dialysis center on the day of death? Why do you think these changes were made?
 
 
6. How does the Emergency Services Trip Record contribute your understanding of the events?
 
 
7. What would you have done differently in the dialysis center?
 
 
8. What ethical issues does this case present?
 
 
9. What’s the difference between a dialysis shunt, graft and fistula?
 
 
10. What are common complications of each?
 
 
11. This patient had three operations for dialysis access. Each clotted and stopped working. How might this relate to the patient’s clinical history?
 
 
12. What is a HeRO graft?
 
 
13. What are some common causes of kidney failure?
 
 
14. What emergencies can be associated with kidney failure?
 
 
15. What emergencies can be associated with dialysis?
 
 
16. How does an arteriovenous fistula work?
 
 
17. Identify where the shunts are based on physical exam. How many did you locate?
 
 
18. Based on the physical exam, which shunt was functional? What was your clue?
 
 
19. What evidence of emergency services can you identify?