Ketorolac for Renal Colic – 10, 20, or 30mg IV?
Is There a Better Way to Image Renal Colic?
Ultrasound appears to be best in most renal colic clinical scenarios. CT is best in older patients (especially with no stone history), those with tenderness on abdominal exam, and those with uncontrolled pain.
New IDSA Guideline on Asymptomatic Bacteriuria
The IDSA now only recommends screening for and treating asymptomatic bacteriuria (ASB) in pregnant women and those undergoing an invasive urologic procedure.
Dealing With the ESBL Threat – Extended Spectrum β-lactamase Enterobacteriaceae
Highly resistant, extended spectrum β-lactamase (ESBL) producing Enterobacteriaceae in the urine are becoming increasingly common in unexpected patients in the ED.
What Doesn’t Work for Renal Colic
Neither IV magnesium nor intranasal desmopressin provided any additional pain relief when used as an adjunct to NSAIDs for renal colic.
Transgender Care
There was a helpful JAMA Internal Medicine article on caring for transgender patients this past month. This will help us apply it in the ED.
Tamsulosin Didn’t Help Pass Kidney Stones
This large RCT found tamsulosin was of no benefit for kidney stone passage at 28 days, regardless of size or location.
POCUS for Kidney Stone – Be Careful
Point-of-care ultrasound in patients with renal colic had tepid diagnostic accuracy for nephrolithiasis. If hydronephrosis was present, specificity was 94% and often indicated a stone >5mm.
Nitrofurantoin Beats Fosfomycin for UTI in Women
Nitrofurantoin was clearly superior to fosfomycin for uncomplicated UTI in adult women.
Ultrasound or CT for Nephrolithiasis
An ultrasound-first strategy, especially for recurrent kidney stones, was a good way to reduce radiation exposure in patients presenting to the ED with renal colic.