Microsoft word - 2012-10-09-guidesmaster for website pdfs.doc

This is an example practice guide excerpted from one of the 800-page
Practice Guide books p - 180 -
d by Acute Care Horizons, LLC.
For info on this book go to: http://www.acutecarehorizons.com
FLANK PAIN PRACTICE GUIDE
When using any Practice Guide, always follow the Guidelines of Proper Use (page 16). Differential Diagnosis
● Renal colic ● Biliary colic ● Aortic aneurysm ● Mechanical back pain ● Herpes zoster ● Pyelonephritis ● Renal vein thrombosis ● Retroperitoneal bleeding ● Appendicitis Considerations
● Renal colic is most common misdiagnosis of ruptured ● Aortic disease cause more frequent in elderly ● No hematuria on U/A with 10–15% of kidney stones ● Flank ecchymosis indicative of intra-abdominal Evaluation
● Detailed abdomen, back, flank, and neurovascular Musculoskeletal suspected as cause
● No tests unless blunt injury occurred ● Blunt trauma consider x-ray ● CBC and U/A as indicated Kidney stone suspected
CT abdominal/pelvis scan considered
● Aortic cause suspected ● Inadequate response to pain medications D-dimer
● Can be used as screening test to rule out aortic ● Coumadin (warfarin) can cause false negative D- ● Elderly have a positive D-dimer > 50% of the U/A
● UTI symptoms ● Obtain urine C&S if pyelonephritis suspected or a Treatment Options
● Toradol (ketorolac) 30 mg IV with or without Dilaudid (hydromorphone) 0.5–1 mg IV (or other equipotent narcotic) and Phenergan (promethazine) 6.25 mg or Zofran (ondansetron) 4 mg IV for suspected renal ● Do not use Toradol (ketorolac) if creatinine is ● Musculoskeletal can be treated with Tylenol, OTC medication, NSAID or short narcotic course ● Narcotic short course prn on discharge for renal colic pain, with or without Toradol (ketorolac) ● Phenergan (promethazine) prn ● Flomax (tamsulosin) 0.4 mg PO every day for 2-4 ● Simple UTI: Septra DS, cephalosporin or quinolone for ● Pyridium: 200 mg TID prn urinary symptoms — do not ● Pyelonephritis: 10–14 days of simple UTI antibiotic ● IV Rocephin (ceftriaxone) or Levaquin (levofloxacin) × 1 can be given initially Discharge Criteria
● Renal colic controlled ● Simple cystitis ● Pyelonephritis in nontoxic patient and able to hold Discharge instructions
● Flank pain aftercare instructions ● Refer to primary care provider or urologist as Consult Criteria
● Unknown cause of moderate to severe flank pain ● Unable to hold oral fluids down at home ● Heart rate ≥ 110, hypotension or relative hypotension (SBP < 105 with history of hypertension) ● Suspected vascular cause of flank pain ● Toxic UTI patient ● Unable to hold down medications at home ● WBC ≥ 15,000 ● Bandemia ≥ 15% ● New onset anemia ● Inadequate renal colic relief ● Age ≥ 60 without firm diagnosis ● New onset renal insufficiency or worsening renal ● Solitary kidney with ureteral calculus ● Pyelonephritis with ureteral calculus Notes _____________________________________ _____________________________________ _____________________________________

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