First 5 minutes and stabilization
›Immediate stabilization
›Continuous monitoring when unstable or significant bleeding concern
›Two large bore IV access if shock physiology
›Type and screen if gross hematuria with symptoms or significant ongoing bleeding
›Resuscitation targets
›Crystalloid bolus for hypotension if not cardiogenic
›Blood products per hemorrhage protocol local protocol dependent
›Initial diagnostic bundle
›UA with microscopy
›CBC
›Creatinine and electrolytes
›Conditional diagnostics
›If fever or systemic toxicity, urine culture and sepsis labs
›If flank pain colic, CT KUB or ultrasound based pathway local protocol dependent
›If suspected glomerular, urine protein quantification and targeted serologies
›Analgesia and antiemesis
›Acetaminophen oral 1000 mg
›Ondansetron oral dissolving 4 mg
›Infection treatment pathway
›Antibiotics guided by suspected site and local antibiogram local protocol dependent
›If obstructed infected system suspected, broad spectrum IV antibiotics and urgent decompression
Clot retention and catheter management
›Urinary retention management
›Bladder scan for retention confirmation
›Large bore Foley catheter selection if gross hematuria with clots local protocol dependent
›Irrigation strategy
›Manual irrigation for clot evacuation per urology protocol
›Continuous bladder irrigation for recurrent clotting per urology protocol
Anticoagulation and coagulopathy
›Antithrombotic management principles
›Do not stop anticoagulation without weighing thrombosis risk and consulting relevant service when high risk
›Reversal strategies are indication specific and local protocol dependent
›Reassessment timing
›Repeat vitals every 15 to 30 minutes when unstable
›Urine output monitoring when retention or AKI concern
›Reassessment triggers
›Worsening pain
›New fever
›Drop in hemoglobin
›Inability to clear urine of clots