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Remember if you give tamsulosin to a patient (particularly a female) they need to be aware that if they ever need cataract surgery they have to let the opthalmologist know because they will need a different procedure to prevent a major complication (don't ask me what procedure :))Thanks
Appropriately so, AAA was discussed as an essential part of the differential diagnosis when evaluating kidney stones. I have had two cases where PE was "disguising itself" as renal colic. One patient was a long haul trucker with flank pain and a history of kidney stones. He had no hematuria and negative imaging. As I was leaving the room after his discharge interview he mentioned, "funny thing doc, it hurts worse when I breath". He and I were 3 seconds away from a missed PE. The second patient was sent in for flank pain after GU surgery and her surgeon was concerned about kidney stone v. ureteral injury during surgery and requested CT. After negative urine and CT it hit me that she had just had surgery and was at risk for PE, which she had. Both these patients had lower lobe PEs and I am grateful to the trucker who saved himself and me.
Our Urology group always requests for no NSAIDs within 5 days of lithotripsy. I've actually been fussed at by a Urologist when trying to arrange outpatient follow-up for a stone patient because I'd given him Toradol, and therefore blown his chances at getting lithotripsy for at least a week. Do NSAIDs create that much of a bleeding risk for that procedure? Are NSAIDs a hard and fast contraindication in lithotripsy, or is it more of a loose recommendation? I hate having to commit someone to opiates for pain control if an NSAID would suffice.
First and foremost let me say I love EMRAP and have been listening for years. I recently listened to the C3 on kidney stones and one possible treatment option was omitted. I reached out to my former program director to obtain the specific study and it is attached. It’s not a slam dunk but not a huge downside to using dimendydramine for renal colic pain. I have been using it for several years and have had good results. It’s probably not as enjoyable for men as sex 3 times a week but it’s worth a shot!
Also, thoughts on IV lidocaine for renal colic? In the day and age of vast opiate abuse and dependence I think exploring alternative methods for pain control is called for.
Sorry, can’t get it to attach but it was in 2009 by Yilmaz et al. In
What you do matters.