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EM Clerkship

Urinary Tract Infections

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9816 Ratings

🗓️ 21 July 2019

⏱️ 18 minutes

🧾️ Download transcript

Summary


How to Read a Urinalysis



* Signs of Inflammation* Leukocyte Esterace* WBCs



Multiple conditions cause inflammation on a urinalysis. Anything that causes nearby inflammation (appendicitis, pelvic infections, diverticulitis) or slows urine output (dehydration, renal disease) can commonly elevate these markers.



* Signs of bacterial presence (not present in ~25% of proven urinary tract infections!!!)* Nitrites* Bacteria



Asymptomatic Bacteriuria



Generally should NOT be treated with antibiotics. If you were to randomly sample the population you would find bacteria present in approximately…



* 5% of young people* 20% of old people* 50% of patients in long term care



When to Diagnose UTI



* Dysuria AND urinary frequency WITHOUT vaginal symptoms (+LR 20)* Patient self reports that they think their UTI is back (+LR 4)* Urinalysis shows BOTH signs of inflammation and bacterial presence* Combine pretest suspicion with urinalysis findings using clinical judgement



Indwelling Foley Catheters



All patients with an indwelling foley will have a grossly abnormal urinalysis and appearance of urine at baseline. The urinalysis is useless and diagnosis can only be made by clinical judgement



Geriatric Patients



Geriatric patients have minimal symptoms regardless of diagnosis. They can have UTI’s with minimal symptoms. However they can also have appendicitis or kidney stones with minimal symptoms (and asymptomatic bacteriuria at baseline). BE CAREFUL.



Additional Reading



* The best UTI resource I have seen (First10EM)




Transcript

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0:00.0

Hello, med students. My name is Zach Olson, and thank you for downloading this week's episode of the EM Clerkship Podcast.

0:09.7

We are still cruising through our summer of abdominal inxed. We are covering that huge list of core concepts, the differential diagnosis for abdominal pain.

0:19.0

And so far we've covered the most high-yield GI causes,

0:22.6

and we've started working through our GU causes, the pelvises. Last week, we talked about

0:28.5

the queen mother of all GU critical diagnoses, ectopic pregnancy. All women of childbearing age

0:36.5

with abdominal pain or vaginal bleeding need

0:38.8

a pregnancy test. This week, though, I'm going to take it in a completely opposite direction.

0:45.9

And to be honest, this topic isn't even on the CDM curriculum, even though it probably should be.

0:51.1

This is a lecture you might not hear in residency. And I think it's probably one of the

0:56.2

most high-yield discussions I can never have with you, if I'm honest. And so let me preface this

1:01.0

by saying one of the single best lectures I've ever heard, ever, regarding emergency medicine,

1:07.2

at least, which kind of turned me on to this topic and you should absolutely

1:11.7

listen to it was the EM cases podcast UTI episode. It was episode 94 because it was just so

1:20.1

counter to what I was taught at Ohio State in medical school. It was so counter to what I was

1:25.4

seeing done in residency at UT. It was so opposite

1:29.0

of just how I was practicing. And so it was on the show, it was Justin Morgan Stern. I think

1:36.4

that's how you say it. He was on that episode. And so he has a blog called First 10 EM that covered

1:42.4

UTI as well. And there was kind of a lot of overlap.

1:45.8

And so these are my kind of my primary sources today, just kind of FYI.

1:50.8

It was some of the best content I feel like has ever been put out there.

1:55.0

And it was regarding this, like, quote, boring topic, urinary tract infection.

1:59.0

So let's go this week.

...

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