How to Treat Infected Kidney Stones
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All patients with infected ureteral stones necessitate a urine culture, antibiotics, and urology consultation in the ED, with the majority requiring admission for surgical intervention. Very few, in consultation with urology, who have small, non-obstructing stones and are otherwise young healthy individuals can be discharged with oral antibiotics and close follow up.
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High risk and low prevalence diseases: Infected urolithiasis. Am J Emerg Med. 2024 Jan;75:137-142. doi: 10.1016/j.ajem.2023.10.049. Epub 2023 Nov 3.
How to Treat Priapism
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Priapism is a semi-rare time sensitive emergent disease, and this article is a summary of guidelines for diagnosis and management.
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Diagnosis and Management of Priapism. JAMA vol. 330,6 (2023): 559-560. doi:10.1001/jama.2023.13377
Traction Technique for Manual Detorsion
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Pulling traction on a testicle with torsion is proposed by these authors to help relieve pressure, identify direction of torsion, and to make manual detorsion easier to perform. See figure below for technique.
Don’t Miss Torsion – How to Get the Diagnosis
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Diagnostic characteristics that help differentiate testicular torsion from other causes of acute scrotal pain include vomiting, age > 13, scrotal edema, and palpation of a hard testis. Use caution with normal ultrasound results in those with high pretest probability.
Source
Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience. Emerg Med J. 2022 Dec 16;emermed-2021-211946. doi: 10.1136/emermed-2021-211946. Online ahead of print.
Fluoroquinolone Resistance in UTI – Is It Time to Change Drugs?
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Fluoroquinolone-resistant (FQR) E. coli was present in 22.1% of UTI pathogens studied at 15 geographically diverse EDs. IDSA guidelines recommend changing empiric treatment if local resistance is >10% and adding a dose of parenteral antibiotic, such as ceftriaxone, prior to discharge home.
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High prevalence of fluoroquinolone-resistant UTI among US emergency department patients diagnosed with urinary tract infection, 2018-2020. Acad Emerg Med. 2022 Sep;29(9):1096-1105. doi: 10.1111/acem.14545. Epub 2022 Aug 5.
The Downside of Antibiotics for UTI
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Antibiotics have a good and bad side for women with uncomplicated cystitis. Use of trimethoprim-sulfamethoxazole (TMP-SMX) and other antibiotics, when compared to nitrofurantoin, had higher risk of adverse events.
Source
Association of Adverse Events With Antibiotic Treatment for Urinary Tract Infection. Clin Infect Dis. 2022 Apr 28;74(8):1408-1418. doi: 10.1093/cid/ciab637.