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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 Play in new window | Download Date:  April 11, 2014  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...

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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 Play in new window | Download Date: April 14, 2013 Case Scenario: A 46-year-old 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: 10.1002/14651858.CD004926.pub3. Population: Adults...

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

Posted by on Sep 16, 2012 in Featured, Genitourinary, Podcasts | 4 comments Play in new window | Download Date: September 6, 2012 Case Scenario: A 49 year old man presents to the ED with his typical problem of renal colic. 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. 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. Intervention: Tamsulosin 0.4mg OD Control: Placebo Outcome: Time to stone expulsion from inclusion in study up to 42 days. Authors’ Conclusions: “Although well tolerated, a daily administration of 0.4 mg of tamsulosin did not accelerate the expulsion of distal ureteral stones in patients with ureteral colic” BEEM Commentary: Renal...

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