Cannot miss / life threats
Cannot miss / life threats
Differential diagnosis β checklist
0/22
Check off each diagnosis as you consider it. Tap the name for unique exam, lab/imaging clues, first-line confirmatory test, and management.
Infectious β urinary0/7
Infectious β STI / genital0/5
Non-infectious / structural0/7
Cannot-miss surgical / systemic0/3
Initial ED workup
Bedside0/5
- Vitals + temperature; check for SIRS/sepsis
- Focused GU/pelvic exam (rule out Fournier, retention, prostate tenderness, vaginitis, ulcers)
- Bladder POCUS for retention; renal POCUS for hydronephrosis
- Urine dip / point-of-care UA
- Urine pregnancy test in any reproductive-age female
Labs0/7
- UA with microscopy + urine culture (mid-stream or catheterized)
- GC / Chlamydia NAAT when STI suspected (also pharyngeal/rectal per exposure)
- Wet mount + KOH + vaginal pH for vaginitis
- CBC, BMP, lactate if febrile or systemically ill
- Blood cultures Γ 2 if febrile / septic / immunocompromised
- HIV + syphilis (RPR) screening for any new STI
- PSA only if prostatitis suspected (interpret cautiously)
Imaging0/5
- Bedside US: bladder volume, hydronephrosis, scrotal Doppler if testicular pain
- Non-contrast CT abd/pelvis if stone suspected
- Contrast CT abd/pelvis (with IV contrast) if abscess, emphysematous pyelonephritis, or complicated pyelo
- CT pelvis (with IV contrast) with soft-tissue windows if Fournier suspected (do not delay surgery for imaging)
- Transvaginal US for PID / TOA / ectopic
Initial management0/6
- IV access, fluids, analgesia (ketorolac for renal colic; acetaminophen + opioid PRN), antiemetic
- Empiric antibiotics per syndrome and local antibiogram (do not wait for cultures if febrile/septic)
- Phenazopyridine 200 mg TID Γ 2 d for symptomatic dysuria (warn re: orange urine)
- Decompress obstruction urgently (Foley for retention; urology stent/nephrostomy for obstructed infected stone)
- Treat sexual partners; counsel on safe sex; report STIs per local requirements
- Admit: pregnant pyelo, sepsis, intractable vomiting, immunocompromised, obstructed system, men with febrile UTI, suspected abscess, Fournier (OR)
Pearls / pitfalls
Pearls
- Fever + flank pain + obstructing stone = urologic emergency β needs decompression, antibiotics alone are not enough.
- Always Ξ²-hCG before imaging or antibiotics in reproductive-age females; ectopic can mimic UTI.
- Pain out of proportion + perineal erythema/crepitus in a diabetic = Fournier until proven otherwise β go to OR.
- Asymptomatic bacteriuria: treat ONLY in pregnancy and before urologic procedures.
- Recurrent 'UTI' in a man, child, or postmenopausal woman β image and refer to urology.