EMRA Simulation Guide

GU - Obstructive Nephrolithiasis

CASE: 45-year-old male presents with flank pain

Learning Objectives

1. Create a differential for flank pain
2. Order appropriate studies to elucidate the cause of the patient's flank pain
3. Recognize what imaging is most appropriate for diagnosis of obstructive nephrolithiasis
4. Discuss management of obstructive nephrolithiasis

Critical Actions

• Obtain IV access with a large-bore peripheral IV
• Place patient on monitors with continuous oxygen saturation and vital monitoring
• Ask for a full set of vital signs including HR, BP, oxygen saturation, and temperature
• Obtain EKG
• Ask for and interpret appropriate labs (CBC, Cardiac Biomarkers, Chemistry, LFTs, Lipase, UA, and Urine Culture)
• Administration of IV fluids
• Administration of analgesics
• Request imaging- CT or US
• Reassessment of patient’s pain and vital signs
• Appropriate consultations called (urology)
• Closed loop communication
• Synthesis of the case
• Disclose appropriate information to the patient/family
• Summary of case to team or consultant

Download the case here.