Genitourinary Archives - The Emergency Medical Minute

Genitourinary

Podcast # 455: Hunting for PeeCP

Author: Michael Hunt, MD Educational Pearls:   Like all tests, urine toxicology (utox) screens can have false positives Prescription medications such as demerol, antipsychotics, ketamine, and tramadol can all produce a false positive utox for PCP Over-the-counter medication such as dextromethorphan also mimic PCP on utox   References Doyon S. (January 2014). False Positive Urine…

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Podcast # 432: Hunting for UTIs

Author: Michael Hunt, MD Educational Pearls: As many as 20% of women in assisted living have asymptomatic bacteriuria This can present a diagnostic conundrum when seeing these patients in the emergency department, particularly for altered mental status and deciding whether to treat True diagnosis of UTI in the emergency department is difficult as true diagnoses…

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Podcast #375: Retrograde Urethrogram

Author:  Jared Scott, MD Educational Pearls: Blood at urethral meatus in trauma can be a sign of bladder/urethral injury Blind placement of a Foley catheter can make an undiagnosed urethral injury worse Urethral injury is evaluated using a retrograde urethrogram (RUG) If urethra is confirmed to be intact, Foley catheter can be placed to allow…

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Podcast # 344: Foley troubleshooting

Author: Aaron Lessen, MD. Educational Pearls: When foley is stuck, balloon may not have deflated. Make sure balloon is not in the urethra, which can block drainage. Cut off the port as it may be obstructed. If still not draining, pass guide wire through port to unclog catheter. Other techniques have been described using mineral…

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Podcast #309: Return Visits to the ED for UTI

Author: Alicia Oberle, MD Educational Pearls: Recent study has shown risk factors for return included patients at high risk for resistance (nursing home, obstructive uropathy), patient where diagnogsis of pyelonephritis was missed, but the biggest risk factor was the existence of bug-drug mismatches. Cephalexin (Keflex) was associated with highest rate of return, while nitrofurantoin (Macrobid)…

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Podcast #295: UTI

Author: Sam Killian, M.D. Educational Pearls Traditionally, UTI diagnosis has been dependent on urine culture, urinalysis and clinical symptoms. But a recent study casts some doubt on the utility of urine cultures. A study in the Journal of Clinical Microbiology did urine cultures and E. coli PCR in 220 women with UTI symptoms and 86…

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Podcast #294: Rhabdomyolysis

Author: Michael Hunt, M.D. Educational Pearls Rhabdomyolysis is caused by the destruction of skeletal muscle that leads to the release of myoglobin, which causes renal failure. It presents with pain and weakness in the affected muscle, as well as dark urine. Diagnosis is made with creatinine kinase levels It can happen to extreme athletes after…

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Deep Dive #6: Bacteriuria and the Elderly

Author: Heidi Wald, MD, MSPH  Associate Professor of Medicine – University of Colorado School of Medicine, Physician Advisor – Colorado Hospital Association Dr. Heidi Wald explains common misconceptions of UTI’s in elderly patients and provides tips on how to properly identify them. References: Trestioreanu , Adi Lador , May-Tal Sauerbrun-Cutler and Leonard Leibovici  Antibiotics for asymptomatic bacteriuria  Cochrane…

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Podcast #216: Roller Coasters and Kidney Stones

Author: Aaron Lessen, M.D. Educational Pearls: Anecdotal evidence suggests that roller coasters may help with kidney stones. A recent study used a model of a kidney and ureter with different sized stones and put it on Thunder Mountain roller coaster in Disney World. There was “dramatic passage” of the kidney stones at the rear of…

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Podcast #206: Urethral Injuries

Author: Jared Scott, M.D. Educational Pearls: DDx for blood at urethral meatus includes: pelvic fracture, ruptured bladder, kidney laceration, penile trauma. Retrograde Urethrogram (RUG) must be performed before placing foley and is critical for diagnosis. References: https://www.ncbi.nlm.nih.gov/pubmed/16488282  

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