Kidney Stones (Renal Calculi)

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Rx: (http://www.pemcincinnati.com/bl…/kidney-stones-04-treatment/ )

  • For pain: NSAIDs (avoid in kidney disease) then Opiates
  • Antiemetics: If the patient is nauseous and vomiting
  • Fluids: You do NOT need to give fluids if your patient is not dehydrated

Ix: (http://www.pemcincinnati.com/blog/kidney-stones-02-labs/ )

Admit if: (http://www.pemcincinnati.com/bl…/kidney-stones-04-treatment/ )

  • Needing lots of IV pain meds
  • Can’t tolerate oral fluids
  • Large stone >>10mm and urology is considering intervention. 90% of patients will pass stones regardless of size.
  • UTI + stone and ill appearing

Harmless kidney stone or cancer…your call

Top 10 reasons NOT to order a CT scan for suspected renal colic

  1. Cancer risk
  2. Patient expectations
  3. Imaging begets imaging
  4. Generally good prognosis
  5. Hydronephrosis is not an emergency
  6. Imaging begets urology referrals
  7. Wait and see
  8. Reframing the question
  9. UA + US = done
  10. Low dose CT

Ultrasound Vs. CT Scan for Diagnosing Renal Colic

Emergency medicine physicians should consider ultrasound for suspected nephrolithiasis when appropriate. We could be doing a favor for our patients in reducing radiation exposure, and are not putting the patient at increased risk or harm.