Obstructive uropathy: stone blocking ureter, N/V, sharp 10/10 intensity abdominal pain (diffuse tenderness but worse on 1 side), CVA tenderness (worse on 1 side) that radiate to groin on same side), dizzy, drowsy, disoriented, weak, fever, chills, diarrhea
- Admit to ICU
- Consult Urology (Dr. Rogers, Dr. Todd Olsen, Dr. Beird?) for obstructive uropathy – may place stent emergently to allow urine to pass through ureter and mitigate pathology to obstructed kidney
- Hypotension: Give multiple L NS IV boluses (follow BP closely). If BP remains unstable, consider starting Levophed (Norepinephrine, pressor, vasoconstricts). Other: Consider that the patient may have adrenal insufficiency and therefore give a steroid since the patient’s body may not be able to produce enough cortisol on its own. Cortisol causes blood vessels to become more sensitive to NE and therefore facilitates vasoconstriction to maintain BP. When Cortisol level is low, such as in the presence of adrenal insufficiency, the patient may remain hypotensive and not respond well to NE.
- Start empiric antibiotics: Vancomycin (MRSA) and Meropenem (Gram negative rods: E.coli or Pseudomonas)
- Order UA, Urine culture, and Blood culture.
- Patient may have elevated Troponins (secondary to acute renal failure and sepsis with severe hypotension): Repeat serial Troponins and do EKG. If Troponins remain elevated and patient has a Hx of CAD, consult cardiology.