Acute Onset Fever and pain with urination


• Scene – EKG, IV, BG, TT,vitals

• En route – vitals


• Pt was transported to hospital


Elliot Williams, Paramedic Woodburn Ambulance


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Fever

Differential Diagnosis

• Lower tract UTI

• Pyelonephritis

• Stent infection

• Sepsis

• Kidney stone (nephrolithiasis)

• Ureteral stone

Patient Workup History

• Patient states – pt had ureteral stent placed a few weeks prior. She will have kidney stones removed with a laser next month.

• She has had discomfort since the stent was placed and thinks she may have an infection

• Pt has been taking ibuprofen throughout the night for fever

Physical Exam

• Fever, tachycardia

• CBG – 15

• EKG – ST

Editor’s Notes

This patient’s recent history of urologic surgery may prove key to her diagnosis. UTIs can be acute or chronic. Pain can be significant. Managing pain en route is key, with frequent pain assessments. The patient’s tachycardia may be related to pain and/or fever.

-Dr. David Spiro


• Gender: Female

• Age: 51 years

• Height: N/A

• Weight: N/A


• Temperature: 102.1 F/38.9 C

• Blood Pressure: 125/61

• Heart Rate: 106

• Respiratory Rate: 16

• Pulse Oximetry: 98% RA

Signs and Symptoms

Fever since last night; discomfort to vaginal area with some small blood clots when wiping.

History Medical

• PHM: Gallbladder removed, sleep apnea

• Allergies: Green dye

• Dispatch info: C/B/A with high fever


• Lives alone in an apartment


• Tolterodine, Tamsulosin, Zofran, Buspirone, Trazadone, Ampheta, Wellbutrin, Oxycodone, Vyvanse, Melatonin

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