Editing Stones: Evaluation and Medical Management (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'''
** '''Acetaminophen 1000 mg PO'''
** '''1 L 0.9% NS bolus'''
**Cardiac Lidocaine 1.5 mg/kg IV in 100 mL NS over 10 minutes (MAX 200 mg)
*'''<span style="color:#ff0000">Urologic Emergency: 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.