- UTI’s in Adults
- Renal Calculi
- Bladder (Vesical) Calculi
- Acute Scrotal Pain
- Acute Urinary Retention
Kidney Stones (Renal Calculi)
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/ )
- Urinalysis: No blood on a urinalysis does NOT rule out a kidney stone.
- Check creatinine
- Get the Ultrasound first. If it is negative, and you still need to identify the stone get a Non-contrast CT scan. (http://www.pemcincinnati.com/blog/kidney-stones-03-imaging/ )
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
- Avoid CT of the head in asymptomatic adult patients in the emergency department with syncope, insignificant trauma and a normal neurological evaluation.
- Avoid CT pulmonary angiography in emergency department patients with a low-pretest probability of pulmonary embolism and either a negative Pulmonary Embolism Rule-Out Criteria (PERC) or a negative D-dimer.
- Avoid lumbar spine imaging in the emergency department for adults with atraumatic back pain unless the patient has severe or progressive neurologic deficits or is suspected of having a serious underlying condition, such as vertebral infection or cancer with bony metastasis.
- Avoid prescribing antibiotics in the emergency department for uncomplicated sinusitis.
- Avoid ordering CT of the abdomen and pelvis in young otherwise health emergency department patients with known histories of ureterolithiasis presenting with symptoms consistent with uncomplicated kidney stones.