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Spencer is a PGY-3 Resident in the Emergency Medicine program at the University of Arkansas. Case: A 36 year old previously healthy white male is attending his families thanksgiving supper. SGEM#32: Stone Me was a Chochrane Systematic Review looking at fluids and diuretics for rental colic. The last time we reviewed renal colic was another Chochrane Systematic Review from Zue et al. This time we are not going to be talking about renal colic treatment but rather diagnostic strategies. Clinical Question: In ED patients with suspected renal colic, is ultrasound as effective as CT as a diagnostic tool?
Population: 2,759 patients 18-76 years of age in emergency department setting from 15 geographically diverse academic emergency departments. Primary outcome(s)– 30-day incidence of high-risk diagnosis with complications related to missed or delayed diagnosis and 6-month cumulative radiation exposure. Secondary outcome(s)– serious adverse events, related serious adverse events, pain, return ED visits, hospitalizations, and diagnostic accuracy.
The study did not comment on whether groups were treated differently with regards to disposition, treatment, and follow-up, based on results from different imagine modalities. This study provides strong enough evidence that there is no harm to implementing ultrasonography for suspected nephrolithiasis, and is benefit in reducing radiation exposure.
Comment on author’s conclusion compared to SGEM Conclusion: Author’s conclusions are similar to our conclusion, in that ultrasonography for suspected nephrolithiasis reduces cumulative radiation exposure without significant differences in bad outcomes as compared to computed tomography. SGEM Bottom Line: Bedside emergency department ultrasound is safe and has several advantages over CT for the diagnosis of kidney stones.

Case Resolution: The 36 year old man who presented looking like renal colic gets an ultrasound.
Clinically Application: Emergency medicine physicians should consider ultrasound for suspected nephrolithiasis when appropriate.
Dylan knew that the household device was commonly used in cardiac arrest to provide oxygenation and ventilation in the 1500’s was a bellows. This included a randomized clinical trial done in France looking at the use of tansulosin for the expulsion of distal ureteral stones.
The Bottom Line was tamsulosin was useless in most emergency department patients with ureteral colic unless their stone size exceeds at least 4mm.
NO; patients whom the treating physician considered to be at high risk for serious alternative diagnosis or pregnant were not eligible.
UNSURE; study does not specify the treatment and follow up decisions based on imaging method used and findings. YES; high-risk diagnosis with complications was not statistically significant and the study was statistically significant in regards to cumulative radiation exposure. It is unlikely that this trial will be repeated and supports what many EM physicians suspected in the diagnosis of kidney stones in an ED population.
It should be noted that there were exclusions for obesity in both men and women which could significantly effect the test characteristics of US patients.
This evidence should and will impact clinical care, as physicians should stay away from CT in favor of US to reduce radiation exposure, without added risk by performing US. You also arrange a follow up with a urologist and provide him with strict return precautions. We could be doing a favor for our patients in reducing radiation exposure, and are not putting the patient at increased risk or harm.

I would tell my patients that it looks like you have a kidney stone because you are doing the hippy hippy shake. He says that over the last couple of hours he has felt that it is radiating down towards his groin.
Randomization was performed with the use of the RANUNI function in SAS software at the study website.
His pain and vomiting has settled in the department with intravenous ketorolac and ondansetron. After assignment, the patients’ care during the emergency department visit at the time of enrolment was managed at the discretion of the treating physicians, including decisions about further imaging and the treatment and disposition of the patients. A second relative suggest he has probably been drinking too much which leads to another argument among some of the family members. Another relative who is a nurse suggests it could be renal colic and suggests he goes to the emergency department for assessment. The conclusion was no reliable evidence was available to support the use of fluids or diuretics to treat renal colic. The ultrasound is just as good at diagnosing kidney stones and we may be able to get you out of the emergency department faster.

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