Book contents
- Frontmatter
- Contents
- Acknowledgments
- List of Contributors
- SECTION ONE OVERVIEW AND PRINCIPLES IN EMERGENCY ANALGESIA AND PROCEDURAL SEDATION
- SECTION TWO ANALGESIA FOR THE EMERGENCY PATIENT
- 8 Pharmacology of Commonly Utilized Analgesic Agents
- 9 Patient Assessment: Pain Scales and Observation in Clinical Practice
- 10 Pathways and Protocols for the Triage Patient with Acute Pain
- 11 Patients with Acute Pain: Patient Expectations and Desired Outcomes
- 12 Analgesia for the Adult and Pediatric Multitrauma Patient
- 13 Analgesia for the Emergency Department Isolated Orthopedic Extremity Trauma Patient
- 14 Analgesia for Selected Emergency Eye and Ear Patients
- 15 Analgesia for the Emergency Headache Patient
- 16 Analgesia for the Emergency Chest Pain Patient
- 17 Analgesia for the Emergency Back Pain Patient
- 18 Analgesia for the Acute Abdomen Patient
- 19 Analgesia for the Renal Colic Patient
- 20 Analgesia for the Biliary Colic Patient
- 21 Analgesia for the Chronic Pain Patient
- 22 Outpatient Analgesia following Acute Musculoskeletal Injury
- SECTION THREE PROCEDURAL SEDATION FOR THE EMERGENCY PATIENT
- SECTION FOUR TOPICAL, LOCAL, AND REGIONAL ANESTHESIA APPROACH TO THE EMERGENCY PATIENT
- SECTION FIVE SPECIAL CONSIDERATIONS FOR EMERGENCY PROCEDURAL SEDATION AND ANALGESIA
- Index
- Plate section
- References
19 - Analgesia for the Renal Colic Patient
from SECTION TWO - ANALGESIA FOR THE EMERGENCY PATIENT
Published online by Cambridge University Press: 03 December 2009
- Frontmatter
- Contents
- Acknowledgments
- List of Contributors
- SECTION ONE OVERVIEW AND PRINCIPLES IN EMERGENCY ANALGESIA AND PROCEDURAL SEDATION
- SECTION TWO ANALGESIA FOR THE EMERGENCY PATIENT
- 8 Pharmacology of Commonly Utilized Analgesic Agents
- 9 Patient Assessment: Pain Scales and Observation in Clinical Practice
- 10 Pathways and Protocols for the Triage Patient with Acute Pain
- 11 Patients with Acute Pain: Patient Expectations and Desired Outcomes
- 12 Analgesia for the Adult and Pediatric Multitrauma Patient
- 13 Analgesia for the Emergency Department Isolated Orthopedic Extremity Trauma Patient
- 14 Analgesia for Selected Emergency Eye and Ear Patients
- 15 Analgesia for the Emergency Headache Patient
- 16 Analgesia for the Emergency Chest Pain Patient
- 17 Analgesia for the Emergency Back Pain Patient
- 18 Analgesia for the Acute Abdomen Patient
- 19 Analgesia for the Renal Colic Patient
- 20 Analgesia for the Biliary Colic Patient
- 21 Analgesia for the Chronic Pain Patient
- 22 Outpatient Analgesia following Acute Musculoskeletal Injury
- SECTION THREE PROCEDURAL SEDATION FOR THE EMERGENCY PATIENT
- SECTION FOUR TOPICAL, LOCAL, AND REGIONAL ANESTHESIA APPROACH TO THE EMERGENCY PATIENT
- SECTION FIVE SPECIAL CONSIDERATIONS FOR EMERGENCY PROCEDURAL SEDATION AND ANALGESIA
- Index
- Plate section
- References
Summary
SCOPE OF THE PROBLEM
Kidney stones occur in an estimated 5% of the population at any given time. The estimated lifetime risk for the passage of a renal stone is approximately 10%. After having one episode of renal colic, an estimated 50% of individuals will suffer a recurrence. It is not surprising, therefore, that there are more than 1 million visits to U.S. emergency departments (EDs) each year because of renal colic.
CLINICAL ASSESSMENT
Several studies have assessed the accuracy of the diagnosis of renal colic based on clinical presentation. Although the constellation of flank pain, nausea and vomiting, and hematuria has appeared to be reasonably specific in the classical approach to these patients, more recent investigations have suggested that when computed tomography (CT) scanning of the abdomen and pelvis is performed in the acute setting, important alternate diagnoses are identified relatively frequently.
In one study of subjects who were thought by the treating physician to have a 90–100% likelihood of suffering a first episode of renal colic, 17% were found to have alternate significant pathology. It, therefore, seems prudent to consider imaging in the majority of patients with a suspected initial episode of renal colic (Figure 19-1).
PAIN CONSIDERATIONS
It is believed that the pain of renal colic is largely mediated by the synthesis of prostaglandin E2 in the renal medulla, leading to increased flow through the afferent arterioles and increased renal pelvis pressure. Ureteral smooth muscle spasm may also be a factor.
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- Chapter
- Information
- Emergency Sedation and Pain Management , pp. 127 - 130Publisher: Cambridge University PressPrint publication year: 2008