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…
Read MoreAuthor: 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)…
Read MoreAuthor: 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…
Read MoreAuthor: 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…
Read MoreAuthor: 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…
Read MoreAuthor: 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…
Read MoreAuthor: 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
Read MoreRun Time: 4 minutes Author: Holly Anderson, PharmD PGY-1 Resident Educational Pearls: Patients with pyelonephritis typically show a leukocytosis, fever, nausea, HA, CVA tenderness. Patients with a lower tract UTI will have absence of systemic symptoms with predominantly voiding symptoms of frequency, urgency, dysuria, and hematuria. These 2 types of UTI require different antibiotics and…
Read MoreRun Time: 2 minutes Author: Dylan Luyten M.D. Educational Pearls: An upcoming study in the Journal of Pediatrics, to be published in July, looked at reducing unnecessary urinary catheterization rates in infants. In the study they investigated bagged urines on infants and every infant got a catheter. It was found that if you restricted true…
Read MoreRun Time: 4 minutes Author: Holly Anderson, PharmD PGY-1 Resident Educational Pearls: ASB is defined as an individual with a bacteria count >100,00 or pyuria present on UA. Patients will likely present with another chief complaint and will have no localizing urinary symptoms. ASB is common in elderly patient with an indwelling catheter which frequently…
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