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Renal Calculi: Emergency Department Diagnosis And Treatment - $30.00
This issue includes 4 AMA PRA Category 1 CreditsTM; 4 ACEP category 1; 4 AAFP Prescribed credits; and 4 AOA Category 2B CME credits.
Michelle R. Carter,MD Vice-Chairman and Clinical Director of the Department of Emergency
Medicine, Howard University Hospital, Washington, DC
Brad R. Green, MD
Emergency Physician, Mount Sinai Medical Center Department of
Emergency Medicine, New York, NY
Kevin M. Ban, MD
Department of Emergency Medicine, Beth Israel Deaconess Medical
Center; Assistant Clinical Professor, Harvard Medical School, Boston, MA
Kaushal H. Shah, MD, FACEP
Associate Residency Director, Elmhurst Hospital Center; Associate
Professor, Mount Sinai School of Medicine, New York, NY
Excerpt from the issue...
It’s 8:30 pm and you receive a call from your chairman asking you to stop by the next morning regarding a patient you saw a few days earlier on a busy evening shift. The patient was 46 years old and complained of new-onset right flank pain for 1 day. He had no significant past medical history except chronic back pain, was on no medications, had no allergies, and was a social drinker. He had no other complaints, had stable vital signs, and his examination was only remarkable for mild CVA tenderness. You elected to treat him with oral analgesics and dipped his urine for blood. The patient had reduction of his pain with NSAIDs, and his dip showed no blood. He was discharged to home with a diagnosis of musculoskeletal back pain. The chart seemed to be in order, so why was the chairman concerned?
A 38-year-old woman presents complaining of 4 hours of left back pain. She admits to fevers, chills, and vomiting. She has a medical history of HIV and asthma. Her medications include albuterol and an HIV drug regimen. Social and surgical histories are unremarkable. She is febrile, tachycardic, and in moderate distress with a “colicky” type of presentation. She has blood drawn, urine sent for urinalysis and pregnancy test, and a noncontrast CT of her abdomen and pelvis is ordered to look for a kidney stone. You’re certain it will be positive, but you wonder if her HIV is a complicating factor.
Your last patient of the shift is a 57-year-old woman complaining of 4 hours of abdominal pain. She has a history of hypertension and hyperlipidemia. Her medications include an antihypertensive and her “high cholesterol pill.” She is noted to be restless and in mild distress with tachycardia, which you attribute to pain. Her abdomen is diffusely tender, and she has a moderate amount of blood on her urine dip. You order labs and a KUB followed by an ultrasound to rule out a kidney stone. She is medicated with morphine and is signed out to a colleague with the plan to control her pain and check her studies. When you follow up on her outcome the next morning, you are reminded that the last patient of the day does not always get the best assessment.