Wednesday, June 19, 2013

Kidney Stones

Paramedic Unit dispatched emergency to residence for "pain." Upon arrival, you notice a 82 y/o F sitting upright. She is complaining of "severe side pain" (flank). She states that the pain started "in the middle of the night," and has been "getting worse" since. Pt rates pain a 10 (0-10 scale), and describes it as "severe pain." Denies any vomiting, but is nauseated. Denies dysuria (painful urination). Medical hx of: bypass, "zipper," HTN. She also has kidney issues. She denies dialysis. Meds: Lopressor, others. Allergies: Ibuprofen. Vital signs are: BP 168/96; Pulse 98; Resp 16; SpO2 99% on a NC @ 4 LPM; Skin normal; Sinus on the monitor and sinus on the 12-lead.

1) What is your differential diagnosis?
2) What lead you to this diagnosis?
3) Patient priority?
4) What would be your treatment plan for this patient?
5) Would you give this patient any analgesics? What drug, and dosage?
6) What is a kidney stone?


1) Kidney stones
2) Flank pain, pain on movement, "severe" pain
3) Priority 2
4) ABC, 12-lead ECG, oxygen via NC, IV access, analgesic
5) Fentanyl 50-100 mcg or Morphine 2-5 mg
6) A kidney stone is when crystal pebbles build up in the calculi of the kidney, causing a blockage

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