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SGEM#154: Here I Go Again, Kidney Stone

Posted by on May 15, 2016 in Featured, Genitourinary, Podcasts | 4 comments

Podcast Link: SGEM154 Date: May 12th, 2016 Guest Skeptics: Dr. Tony Seupaul and Dr. Marc Phan. Tony is the Chairman of the Department of Emergency Medicine, University of Arkansas. Marc is a PGY-3 resident in the Emergency Medicine program at the University of Arkansas. Case: 48 year old man presents to the emergency department complaining of right flank pain radiating to his groin. He states the pain comes in “waves,” and he has associated nausea without vomiting. On exam, he is afebrile and appears very uncomfortable while grabbing his right flank. Background: We have covered renal colic a number of times on the SGEM. The last time it was a systematic review on tamsulosin from 2012. The SGEM Bottom Line from that episode was: “Tamsulosin is useless in most ED patients with ureteral colic unless their stone size exceeds at least 4mm.”...

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SGEM#71: Like a Rolling Kidney Stone (A Systematic Review of Renal Colic)

Posted by on Apr 19, 2014 in Featured, Genitourinary, Podcasts | 1 comment

Podcast Link: SGEM71 Date:  April 11, 2014  Classic Guest Skeptics: Dr. Anthony (Tony) Seupaul Chairman of the Department of Emergency Medicine, University of Arkansas for Medical Sciences and Dr. Joshua Hughes one of his star residents. Case Scenario: A 36 yr old previously healthy white male that comes into the emergency department mid morning one Sunday after about 10 hours of right flank pain he describes as sharp/stabbing and that has progressively become worse since onset. He says that over the last couple of hours he has felt that it is radiating down towards his groin. He has been “sick to his stomach” but has not vomited. He denies seeing any blood in his urine and has not experienced any pain with urination. He denies any diarrhea. He has not had any fever that he knows of. He denies any previous pain...

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SGEM#32: Stone Me (Fluids and Diuretics for Renal Colic)

Posted by on Apr 14, 2013 in Featured, Genitourinary, Podcasts | 0 comments

Podcast Link:SGEM32 Date:  April 14, 2013 Title: Stone Me (Fluids and Diuretics for Renal Colic) Case Scenario: A 46yo man presents to the emergency department doing the renal colic shuffle (not the Harlem Shake). He has a history of kidney stones. Nothing in his physical examination or investigations suggest anything other than another renal colic attack. He wants to know if there is a way to flush the stone out. From TheSGEM Episode #04 (Getting Un-Stoned) you know that an apha blocker does not help pass stones beyond the placebo effect. We are still waiting for the big systematic review by Zhu from Cochrane on the topic. Question:  Does pushing oral/IV or diuretics help in passing kidney stones? Reference:  Worster AS, Bhanich Supapol W. Fluids and diuretics for acute ureteric colic. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD004926. DOI:...

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Podcast#4: Getting Un-Stoned (Renal Colic and Alpha Blockers)

Posted by on Sep 16, 2012 in Featured, Genitourinary, Podcasts | 4 comments

The Skeptics Guide to Emergency Medicine Podcast Link:SGEM4 Date: September 6, 2012 Title: Getting Un-Stoned Case Scenario: 49 year old man presents to the ED with his typical problem of renal colic. The Question: Is an alpha blocker safe and effective for the treatment of kidney stones? Reference:  Vincendeau et al. Tamsulosin Hydrochloride vs Placebo for Management of Distal Ureteral Stones. Arch Intern Med. 2010;170(22):2021­2027 PMID: 21149761 Population:  129 adult patients with acute renal colic presenting to ED with stone size of 2­7mm. Intervention:   Tamsulosin 0.4mg OD Control:  Placebo Outcome: Time to stone expulsion from inclusion in study up to 42 days. Exclusion criteria: Pregnant or breastfeeding women, patients receiving alpha or beta-blockers, those with   transient hypotension, those with liver impairment, and those requiring a surgical procedure because of infection or continuation of pain after medical treatment were excluded.  Patients with spontaneous passage before randomization were also excluded. Study Author Conclusions: “Although well tolerated, a daily administration of 0.4 mg of tamsulosin did not...

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