Urolithiasis is one of the more frequent diagnoses we are faced with in the Emergency Department, with an estimated 1 million ED visits due to renal colic. As such we are tasked with its diagnosis, prognosis and treatment. The following is a brief summation of the evidence regarding some of the most frequent questions encountered when diagnosing and managing urolithiasis. Four questions are answered by Rory Spiegel on this BEEM Cases. What is the optimal initial imaging modality for the diagnostic work-up of urolithiasis? Once the diagnosis of renal colic has been made what is the most efficacious analgesic strategy? Is there clinical utility to IV fluid administration in the management of renal colic? What is the use of medical expulsion therapy in the management of urolithiasis?
Traditionally we've run at least 2 troponins 6 or 8 hours apart to help rule out MI and recently in algorithms like the HEART score we've combined clinical data with a 2 or 3 hour delta troponin to help rule out MI. The paper we'll be discussing here is a multicentre/multinantional study from the Canadian Medical Association Journal from this year out of Switzerland entitled "Prospective validation of a 1 hour algorithm to rule out and rule in acute myocardial infarction using a high sensitivity cardian troponin T assay" with lead author Tobias Reichlin. It not only looks at whether or not we can rule out MI using a delta troponin at only 1 hour but whether or not we can expedite the ruling in of MI using this protocol.