- UTI’s in Adults
- Prostatitis
- Renal Calculi
- Bladder (Vesical) Calculi
- Acute Scrotal Pain
- Acute Urinary Retention
- Hematuria
Renal Calculi
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
Top 10 reasons NOT to order a CT scan for suspected renal colic
- Cancer risk
- Patient expectations
- Imaging begets imaging
- Generally good prognosis
- Hydronephrosis is not an emergency
- Imaging begets urology referrals
- Wait and see
- Reframing the question
- UA + US = done
- Low dose CT
EM Don’ts
- 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.
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.