MDM - Kidney Stone (Female)

[##]-year-old male with [dysuria/hematuria/flank pain] with history and exam consistent with likely ureteral stone.

Initial consideration in this patient included ureteral/kidney stone, urinary tract infection (UTI), pelvic inflammatory disease (PID), pyelonephritis, testicular torsion, back pain (including herniated disc, musculoskeletal causes, and cauda equina), and sexually transmitted infections among others.

Patient presented with [left/right/bilateral] flank pain with report of [prior/no prior] episodes of kidney stones [additional details].  Patient was noted to have hematuria on urinalysis without findings suggestive of UTI.  Patient without fever or other systemic infectious symptoms.  [Formal/Bedside] ultrasound obtained with [no/evidence of stone/hydronephrosis].  Based on lack of evidence of hydronephrosis [in a patient with a history of passing prior stones without intervention], it was felt that the stone had a high likelihood of passing without intervention.  

CT was obtained with evidence of [describe stone], and [with/without significant] hydronephrosis.  Based on stone size [1-4 mm (78% passage rate)/5-7 mm (60% passage rate/>8 mm (39% passage rate) it was felt that the stone had a high likelihood of passing without intervention/a consult was placed for Urology follow up/case was discussed with Dr. NAME of Urology].  Negative pregnancy test in the ED making pregnancy-related complications unlikely.  No significant pelvic pain, vaginal bleeding, or vaginal discharge to suggest PID.  Labs were obtained and [noted to be unremarkable/notable for specific abnormalities].  Pain improved  with [Kertorolac (Toradol)/intravenous lidocaine/opioids] in the ED.  [Discussed with Dr. [NAME] of Urology with discuss recommendation].  Referral placed for Urology follow up, and discussed with patient prior to discharge. 

Discussed return precautions, specifically for evidence of infected stone or worsening pain, treatment with analgesics and [Tamsulosin (Flomax)], and follow up with primary care doctor within [2-3 days/1 week] and Urology [at the next available appointment/time/date] for further evaluation, and the patient demonstrated understanding and agreement.

http://www.emdocs.net/nephrolithiasis-diagnosis-management-ed/

https://rebelem.com/can-tamsulosin-get-that-stone-to-drop/