Emergency Dept Case StudiesEmergency Dept Case StudiesRenal Colic:Renal Colic:

A 47yo man presents with l flank pain since yesterday. He has pain with urination, nausea, no vomiting. VS: 158/80, hr 104, RR 18, temp 98po. Urine dip at triage is positive for a large amount of RBC’s. The patient appears uncomfortable, rolling around on stretcher. How do you proceed in caring for this patient?

Place an IV, infuse IVF, send bloods (usually bun/creat at least)

Have EW MD evaluate and order pain meds

Send formal u/a

What meds are typically given in these situations?

IV toradol 15-60 mgs, morphine if no relief with toradol

Compazine or droperidol prn nausea

                                                                                                                                          

  

What diagnostic tests would you anticipate?

CT urogram. Ensure bun/creat sent prior

The patient returns from CT looking more comfortable, is on his second liter of IVF and has passed 400cc’s in CAT Scan. The scan showed a two mm stone, no obstruction. What do you anticipate?

If the patient’s pain is controlled, he is able to eat and drink, passing urine, he will be discharged to home. Your d/c instructions should include: drinking plenty of fluids, straining all urine, GU follow up and script for pain meds, instructions for when to return to the ED.