Radioly 1092 is 3 radio.

Dr. Helman here.

Are you taking care of the 72-year-old diabetic woman, first name S-U-E, last name Y-U?

Yeah, Sue U, but 13. I need a CT to rule out a diverticular abscess or perf, please.

Well, I won't be able to rule out a subtle abscess or perf without contrast. Okay, so let's give contrast then. Well, you know her GFR is only 27, and she's at a really high risk for contrast-induced nephropathy. Is she really that sick? Can't you hold off on the CT until her renal function improves? I wouldn't want you to put this patient into worse

renal failure. Hmm. I thought that post-contrast induced nephropathy wasn't really a thing anymore.

Tell that to the patient when she goes on dialysis. Well, how about I gave her some fluid? We give

the contrast and I have a sign of consent to treat for them. Fine. Oh, and make sure to hold her metformin for 48 hours

and that she gets her renal function checked right after that.

I'm Anton Hellman.

And I'm Teresa Chan.

I'm Justin Morganstern.

And I'm Rory Spiegel.

And this is the Journal Jam podcast.

For the first time on EM cases, it's my pleasure to welcome onto the Journal Jam show, a special guest, fellow podcaster and Fomite, who's

published a great systematic review on contrast-induced nephropathy, the one and only, Dr. Lauren

Westifer. So please, we've finally got you on the show, Lauren. Welcome to EM cases. My pleasure.

Awesome. So let's go back to the case that started off the podcast.

So you've got this 72-year-old diabetic woman on Metformin who comes into your ED complaining of left lower quadrant pain and fever.

Vitals are stable, but she looks pretty sick and she's bumped her lactate a little bit.

You highly suspect diverticulitis,

and you want to get a CT not only to confirm the diagnosis, but more importantly to rule out

...