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Ultrasound and Renal Stones

Rob Orman, MD and Mike Mallin, MD
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15:40
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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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01:48

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EMRAP 2018 05 May Written Summary 746 KB - PDF

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Dallas Holladay, DO -

Although it doesn't address the index visit, your listener can rest easy that ACEP guidelines recommend against CT scan for patients under the age of 50 with a history of kidney stones presenting with symptoms consistant with that diagnosis.

http://www.choosingwisely.org/clinician-lists/acep-ct-of-abdomen-and-pelvis-for-ed-patients-under-50/

Michael M. -

Great point Dallas! And I think the literature we have now would support extending that thought process to the index visit as well, assuming the patient does not have high risk features.

Nicholas W. -

Agreed with the key points. Since you suggest ct for high risk patients, I assume you mean ct with contrast? I guess this means no more non con CT’s for stones.

Michael M. -

I think the addition of contrast needs to be patient specific. These higher risk patients can still have kidney stones, and non-contrast CT would probably be best for that diagnosis. Personally, I use a combination of my suspicion for stone in combination with a UA for blood to help me decide to add contrast or not.

Jackson H. -

In a straightforward renal colic presentation, I sometimes wonder to myself, "Is this ultrasound result going to alter my management?". No hydro but with a good story and hematuria = pain meds. mild-moderate hydro = pain meds. severe hydro = pain meds. This is oversimplifying it but do you get what I'm saying? Anyone else with me? This isn't my actual practice but I do find a kidney stone workup very unexciting when I realize 95-99% of the time my management will be unchanged regardless.

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