Her medications include albuterol and an HIV drug regimen. She has a medical history of HIV and asthma. She admits to fevers, chills, and vomiting. The chart seemed to be in order, so why was the chairman concerned?Ī 38-year-old woman presents complaining of 4 hours of left back pain.
He was discharged to home with a diagnosis of musculoskeletal back pain. The patient had reduction of his pain with NSAIDs, and his dip showed no blood. You elected to treat him with oral analgesics and dipped his urine for blood. He had no other complaints, had stable vital signs, and his examination was only remarkable for mild CVA tenderness. He had no significant past medical history except chronic back pain, was on no medications, had no allergies, and was a social drinker. The patient was 46 years old and complained of new-onset right flank pain for 1 day. It’s 8:30 pm and you receive a call from your chairman asking you to stop by the next morning regarding a patient you saw a few days earlier on a busy evening shift. Potentially life-threatening diagnoses including abdominal aortic aneurysm, ovarian torsion, and appendicitis may mimic renal colic and must be ruled out. Rapid intravenous (IV) hydration has not shown a benefit. Combining opioids with non-steroidal anti-inflammatory drugs (NSAIDs) is the optimal evidence-based regimen to treat severe symptoms. The diagnostic modality of choice is a noncontrast computed tomography (CT) ultrasonography is preferred in pregnant patients and children. Furthermore, many inflammatory and infectious conditions cause hematuria, demonstrating the low specificity of urinalysis testing. Microscopic hematuria in the presence of acute flank pain is suggestive of renal colic, but the absence of red blood cells does not exclude urolithiasis.
Radio-opaque calcareous stones account for 70% to 75% of renal calculi. Minimal fluid intake, resulting in decreased urine production and a high concentration of stone-forming salts, is a leading factor in renal calculi development. The acute treatment of kidney stones (urolithiasis) addresses pain management and focuses on the effects of the morbidity associated with an obstructed renal system.
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