Renal colic March 2018 | by EMauthor Pain is classically severe, radiating from loin to groin. The patient is often rolling around in agony and unable to get comfortable, associated nausea and vomiting. Abdominal examination is often unremarkable but the presence of an AAA should be actively sought in patients >50 years old, even if haematuric. Investigations Investigation of choice in BTUH is CTKUB. Remember that negative urinalysis for haematuria is thought to have over 90% NPV so think very carefully about ordering a scan if this is the case. CTKUB does not have to be discussed with radiologist, please discuss requests with the senior shop floor doctor. It should only be used in suspected renal calculi and not used as a safety-net scan. In younger patients consider the radiation, and USSKUB by skilled operator may be a good alternative. Stable patients can go to CDU to await the scan. IV paracetamol, IV or PR diclofenac are effective. Absolute referral criteria for admission (via surgical SHO) •Stone 0.5mm or greater •Uncontrolled pain or recurrence of severe pain. •Acute renal impairment •Evidence of systemic infection •Solitary or transplanted kidney During working hours CTKUBs are reported promptly but out-of-hours these will need reviewed by a senior EM doctor. ALL patients who are discharged even with a CT which is negative for a stone should have copy of the notes faxed to the stone clinic on 4644. |
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