June 29, 2018

Background: Ureteric (renal) colic is a common, painful condition encountered in the Emergency Department (ED). Sustained contraction of smooth muscle in the ureter as a kidney stone passes the length of the ureter leads to pain. The majority of stones will pass spontaneously (i.e. without urologic intervention). For over a decade, calcium channel blockers (i.e. nifedipine) and, more commonly, alpha adrenoreceptor antagonists (i.e. tamsulosin) have been employed in the treatment of ureteral colic for their potential ability to increase stone passage, reduce pain medication use and reduce urologic interventions. These interventions were mostly based on poor methodologic studies and meta-analyses of these flawed studies (Hollingsworth 2016)

Over the past 3-4 years, a small number of higher-quality RCTs have been published (Ferre 2009, Pickard 2015, Furyk 2016). These studies have demonstrated a lack of benefit for routine use of alpha blockers. However, secondary outcomes suggest a possible benefit in larger stones (> 6 mm). In spite of recent multiple studies, the use of alpha blockers remains an area of active debate.

March 26, 2018

Background: Welcome back to REBEL Cast episode 47.  In this issue we are going to talk about some recent trials published in the past year that have gotten some love in the FOAMed world.  We have been meaning to discuss these trials, but just simply didn't have the time until now.  What trials are we reviewing?
  • The age of PRBCs in transfusion
  • The usefulness of lidocaine in renal colic
  • The utility of oxygen therapy in Stroke

September 25, 2017

Background: One of the most common imaging modalities used in the emergency department (ED) today is computed tomography (CT) scans using intravenous radiocontrast agents. Use of IV contrast can help increase visualization of pathology as compared to non-contrast CTs. However, many patients do not get IV contrast due to fear of contrast induced nephropathy.  Furthermore, waiting for renal function values delays the care of patients and prolongs time spent in the ED with a potential to increase adverse effects on patient centered outcomes due to delays.

April 4, 2017

Background: The treatment of urinary retention is pretty straightforward; place either a Foley catheter or suprapubic catheter to decompress the bladder.  What is less clear, and more often debated, is if we need to clamp the catheter after 200 – 1000mLs of urine output or just allow complete drainage.  Historic teaching has been to do intermittent volume drainage to avoid complications such as hematuria, circulatory collapse, and worsening renal failure.  I distinctly remember being taught this as a resident, but not sure that I ever evaluated the literature until recently. 

March 24, 2017

Background: In patients with compromised renal function, the use of intravascular iodinated contrast material is generally not given to avoid contrast induced nephropathy (CIN). Currently, there is no treatment for contrast-induced nephropathy, therefore the focus has been on prevention. Guidelines recommend prophylactic prehydration in the prevention of CIN in high risk patients.  These recommendations are based on expert consensus and until now, there has not been a prospective randomized trial of IV hydration versus no hydration in high-risk patients.