Urolithiasis

Kidney Stones (Renal Calculi)

EMKF

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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

EM Don’ts

EMKF

  1. Avoid CT of the head in asymptomatic adult patients in the emergency department with syncope, insignificant trauma and a normal neurological evaluation.
  2. 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.
  3. 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.
  4. Avoid prescribing antibiotics in the emergency department for uncomplicated sinusitis.
  5. 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.