3. Clinical symptoms upon admission:
Pulse (beats/minute)
BP (mmHg) | Temperature ( ◦C) | Respiratory rate (times/minute) | |
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- Myoinflammatory response syndrome (SIRS):
Clinical symptoms:
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4. Paraclinical
4.1. Testing:
- Blood:
K +
mmol/l
Na + mmol/l | Cl - mmol/l | HC T/L | BC G/L | TC G/L | CRP mg/l | PCT ng/ml | |
Urea:………….. mmol/l Cre:………….. umol/l Albumin:…………….. g/l Blood culture:
Negative Positive
Pathogenic bacteria (if blood culture >0): ........................................................................
Sensitive antibiotic group:.................................................................................
- Urine:
BC:………………. Leu/ul Nitrite:
Negative Positive
Urine culture/wet mount: ..........................................................................................
Gram-stained bacteria:......................................................................................
Urine culture under obstruction:
Negative Positive
Pathogenic bacteria (if culture NT >0):
Sensitive antibiotic group:.................................................................................
4.2. Characteristics of stones causing obstruction
Longitudinal size of gravel:……………. mm Number of gravel:………………………. pieces
Gravel location: .....................................................................................................
Kidney stones with:......................................................................................
4.3. Characteristics of the obstructed kidney
- Degree of hydronephrosis: ..........................................................................................
- Fatty infiltration around the kidney or ureter:...........................................
- Fluid collection around the kidney or ureter: ..........................................................................
- Level of kidney absorption: .................................................................................
5. Methods of drainage of obstruction:
- Cystoscopy with retrograde JJ catheter placement: .................................
- Renal drainage through:......................................................................................
- Time to perform drainage of blockage:……….. minutes.
- Time from symptom onset to drainage: #............ hours.
- Urine culture results above obstruction:
Negative Positive
- Pathogenic bacteria: ...................................................................................................
- Sensitive antibiotic group: ...................................................................................
6. Empiric antibiotic groups are indicated:
................................................................ ................................................................ ..........................
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7. Vasopressors:
- Use: No Yes
- Drug name:
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III. AFTER TREATMENT
1. Day 1
Pulse (beats/minute)
BP (mmHg) | Temperature ( ◦C) | Respiratory rate (times/minute) | |
Clinical:
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................................................................ ................................................................ ..........................
................................................................ ................................................................ ..........................
................................................................ ................................................................ ..........................
................................................................ ................................................................ ..........................
Test:
K +
mmol/l
Na + mmol/l | Cl - mmol/l | HC T/L | BC G/L | TC G/L | CRP mg/l | PCT ng/ml | |
Ur:…………. mmol/l Cre:………….. umol/l
2. Day 3
Pulse (beats/minute)
BP (mmHg) | Temperature ( ◦C) | Respiratory rate (times/minute) | |
Clinical:
…………………………………………………………………………………………………………………
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…………………………………………………………………………………………………………………
Test:
K +
mmol/l
Na + mmol/l | Cl - mmol/l | HC T/L | BC G/L | TC G/L | CRP mg/l | PCT ng/ml | |
Urea:…………. mmol/l Cre:…………. umol/l Urine culture on day 3:
Negative Positive
Pathogenic bacteria (if culture result > 0): .................................................................
Sensitive antibiotic group:.................................................................................