Emergency Dept Case Studies
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.