My questions are:
Would the medic and ER physician suspect kidney stones based on her symptoms?
Yes.
Severe flank pain that radiates to the groin; sometimes passing blood in the
urine; sometimes passing “Gravel” or “Sand” in the urine. A history of kidney
stones also would point the way.
What tests
would be administered in the ER to determine the problem?
Urine
clean catch with microscopic exam—this will show traces of blood, even if not
visible to the naked eye. A CBC (Complete blood count) to look for infection.
Kidney stones can contribute to urinary tract infection. A kidney infection
(called pyelonephritis) will cause a fever and sometimes cloudy urine, in
addition to all the above. These patients need to be admitted for IV
antibiotics.
If
a fever is present, cultures will be taken from urine and blood.
An
X-ray—KUB (Kidneys, ureters, bladder) to look for stones. Some kinds show up on
X-ray.
It’s
possible an IVP (Intravenous pyelogram) might be ordered. Dye is given through
an IV line, and X-ray pictures are taken as the dye is excreted by the kidneys.
Stones can appear as negative defects—no dye in those areas. As the dye travels
from the kidney to the bladder via the ureter, a stone blocking the ureter will
show up as a cut-off—the dye doesn’t get past.
Sometimes
an IVP will help pass a stone, but it’s never ordered for that purpose.
I know
people with kidney stones are discharged to go home and pass the stone. Not always. A lot of times we’d give them IV fluid to
help wash the stone down to the bladder.
Is there
ever a time they would be admitted and if so, why? Intractable
nausea and vomiting, dehydration, high fever (101 or above), too-low blood
pressure would all lead to admission. Kidney infection would lead to admission
(see above) because of the need for IV antibiotics.
I want my
character to spend the night at the hospital if realistically possible.
Would she be given pain medication to ease the pain? Yes.
Would she be given pain medication to ease the pain? Yes.
If so when
would that happen? As soon as they determine there’s
no intra-abdominal disaster, like a ruptured appendix or something of that
nature. The pain med would likely be morphine or Demerol, and would be given
IV.
Would they
need to do diagnostic tests first to determine the problem? Yep—see above.
Questions? Comments?
~*~
Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.
Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.
**Thanks to MedicineNet.com for the diagram~*~
Kelly has worked in the medical field for over twenty years, mainly at large medical centers. With experience in a variety of settings, chances are Kelly may have seen it.
Sometimes truth seems stranger than fiction in medicine, but accurate medicine in fiction is fabulous.