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Kidney Stones are a Diagnosis of Exclusion!!!

History
  • Risk factors
    • Age >60
    • Tobacco use
  • Classic presentations
    • Stable with sudden flank/back/abdominal pain or syncope
    • Unstable with pallor, hypotension, and ill appearance
Exam
  • Pulsatile abdominal mass
  • Unstable vitals
Testing Plan
  • Labs
    • TYPE AND SCREEN
    • CBC
    • Electrolytes
    • Coagulation studies
    • Lactic acid
  • Imaging
    • Bedside ultrasound (optimal)
      • Aorta protocol
        • Look for aorta >3cm
      • RUSH protocol
        • Mnemonic: HI-MAP
        • Heart
        • IVC
        • Morrisons Pouch (RUQ)
        • Aorta
        • Pulmonary
    • CT scan with IV contrast (less optimal)
Treatment Plan
  • 2 Large bore IVs (16G)
  • Massive transfusion protocol
    • PRBCs
    • Platelets
    • Fresh Frozen Plasma
  • Blood pressure management
    • Goal Systolic ~100
    • Goal MAP ~60-65
Clerkship Pearls
  • Put AAA in your differential during your presentation for all older patients with back/flank pain
  • Attempt to perform a bedside ultrasound of the aorta OR find recent CT of the abdomen with normal sized aorta
Additional Reading