Renal colic mimics

 

  • Some mimics of renal colic that may arrive at the ED include: upper UTI’s, ectopic pregnancies, ovarian torsion, adnexal masses, testicular torsion, acute aortic syndromes, renal artery aneurysms, renal infarction, splenic infarction, bowel obstruction, diverticulitis, appendicitis, biliary colic, cholecystitis, acute intestinal ischemia, pneumonia, pulmonary embolism, retroperitoneal hematoma, iliopsoas abscess.
  • Focused history and physical exam are paramount due to the multitude of structures in the area and potentially dangerous conditions that may mimic renal colic.
  • Flank pain and hematuria are the hallmarks of renal colic, however, the presentation is variable.
  • Diagnosis can be confirmed with CT scan, which will show most other potential items in the differential if the scan is negative for a stone.

 

ECG findings among patients with Acute Pulmonary Embolism

Pulmonary Embolus

ECG findings among patients with acute PE: tachycardia (38%), T-wave inversion in lead V1 (38%), and ST elevation in aVR (36%). significant EKG findings which predicted mortality were:

  1. Heart rate > 100 beats/min,
  2. S1Q3T3,
  3. complete RBBB,
  4. inverted T waves in V1–V4,
  5. ST elevation in aVR,
  6. atrial fibrillation

The American College of Physicians “best practice advice” for suspected pulmonary embolism

Pulmonary Embolism

The recommendations, based on a literature review and the best available evidence, include:

  • Use validated prediction rules (e.g., Wells or Geneva tools) to estimate a patient’s pretest probability of acute PE.
  • For patients with a low pretest probability who also meet all Pulmonary Embolism Rule-Out Criteria (PERC), neither D-dimer testing nor imaging should be performed. The PERC comprise eight variables (see link below).
  • For patients with an intermediate pretest probability or those who do not meet all PERC, perform high-sensitivity D-dimer testing; imaging should not be done initially.
  • For those over age 50, use age-adjusted D-dimer thresholds (instead of the usual 500 ng/mL) to decide whether to proceed to imaging; patients with a low-age-adjusted level should not undergo imaging.
  • For patients with a high pretest probability of PE, forego D-dimer testing and go straight to computed tomographic pulmonary angiography. If CTPA is contraindicated or unavailable, ventilation-perfusion lung scanning may be used.

 

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