Flank Pain and Kidney Stones
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 19 August 2018
⏱️ 10 minutes
🧾️ Download transcript
Summary
Kidney Stones are a Diagnosis of Exclusion!!!
Step 1: Consider the Differential Diagnosis for Flank Pain
* Appendicitis* Abdominal Aortic Aneurysm* Ectopic Pregnancy* Testicular/Ovarian Torsion* Kidney Stone
Step 2: Diagnose the Kidney Stone
* Option 1- Renal Ultrasound* Findings consistent with kidney stone diagnosis* Hydronephrosis* Lack of ureteral jets (in bladder)* Kidney stones (poor sensitivity for this)* Benefits* Can be performed at bedside* No radiation* Option 2- Non-contrast CT scan* Great for identifying alternative diagnoses
Step 3: Rule Out Infection
* Fevers* Urinalysis with nitrites or bacteria* If present, patient needs antibiotics
Step 4: Control Symptoms
* Analgesics* NSAIDS (such as ketorolac)* Opiates* Antiemetics* Zofran
Step 5: Rule Out Kidney Injury
* Elevated creatinine* Solitary kidney
Admission Criteria for Kidney Stones
* Coexisting Urinary Tract Infection* Unable to Control Symptoms* Renal Injury/Solitary Kidney
Additional Reading
* How to Interpret a Urinalysis (EM Clerkship)
Transcript
Click on a timestamp to play from that location
| 0:00.0 | Hello, med students. |
| 0:02.7 | My name is Zach Olson, and thank you for downloading this week's episode of the EM Clerkship Podcast. |
| 0:12.6 | Let's get back to some clinical content this week. |
| 0:16.0 | Here's your case. |
| 0:23.6 | No four? Okay. |
| 0:24.6 | Yeah, we're in four. |
| 0:26.6 | All right, buddy, you got a 23-year-old female left lower flank pain, sharp, non-radiating, |
| 0:33.6 | complaining at 8 out of 10 on the pain scale. |
| 0:35.6 | Started approximately two days ago, but no related trauma that she can remember anyway. |
| 0:42.3 | No meds, no allergies, no medical history, state she is a runner. |
| 0:46.3 | We did administer 6 milligrams ketamine IV for pain. |
| 0:51.3 | EKG with sinus attack at 120, BP 130 over 80, 98% on room air, and glucose is |
| 0:58.7 | 130 she ate about 20 minutes ago she says anybody have any questions okay |
| 1:06.0 | thank you. |
| 1:16.6 | All right, so bad flank pain. The vast majority of the time when you hear a sign out like this, when you see flank pain on the chart, |
| 1:22.6 | your first thought is probably going to be, especially after you've been doing this for a while, |
| 1:28.9 | this sounds like a kidney stone. |
| 1:30.7 | Let's get them some pain medicine, et cetera, et cetera. |
| 1:33.4 | And the approach to severe, crampy flank pain, which 99% of the time is a kidney stone, |
| 1:41.3 | is pretty easy. |
| 1:42.6 | And that's what we're going to cover today. |
| 1:45.5 | But before we get into that, the key takeaway, the main point to remember for your rotation, |
... |
Please login to see the full transcript.
Disclaimer: The podcast and artwork embedded on this page are from Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD, and are the property of its owner and not affiliated with or endorsed by Tapesearch.
Generated transcripts are the property of Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD and are distributed freely under the Fair Use doctrine. Transcripts generated by Tapesearch are not guaranteed to be accurate.
Copyright © Tapesearch 2026.