Editing Stones: Diagnosis and Evaluation (section)

==Acute Diagnosis and Management==
*'''Diagnosis and Evaluation'''
**'''History and Physical Exam'''
***History
****New-onset urgency and frequency may indicate a stone at the UVJ irritating the bladder
****Sudden relief of flank pain may indicate either passage or forniceal rupture as the pressure in the collecting system dramatically decreases.
***Physical Exam
****Abdomen
****Costovertebral angle tenderness
**'''Labs'''
***'''Urinalysis +/- culture'''
***'''CBC'''
***'''Serum creatinine'''
**'''Imaging'''
*'''Management'''
**Renal colic pain management[https://smhs.gwu.edu/urgentmatters/content/alternatives-opioids-pain-management-ed]
***Toradol 30 mg IV
***Cardiac Lidocaine 1.5 mg/kg IV in 100 mL NS over 10 minutes (MAX 200 mg)
***Acetaminophen 1000 mg PO
***1 L 0.9% NS bolus
**'''<span style="color:#ff0000">If obstructing stones with suspected infection, must urgently drain the collecting system with a stent or nephrostomy tube and delay stone treatment</span>[https://pubmed.ncbi.nlm.nih.gov/27238616/ ★]'''
***Definitive management of the stone should not be undertaken until sepsis has resolved and the infection has been treated with an appropriate course of antibiotic therapy.