›Time critical stabilization
›If SBP < 90 mmHg, resuscitation bay
›If severe pain with peritonitis, surgical consult activation
›If pregnant with pain and bleeding, urgent pelvic ultrasound pathway
Analgesia and symptom control
›Symptom control
›Acetaminophen PO 1000 mg once
›Ketorolac IV 15 mg once
›Ondansetron ODT 4 mg once
›Sequencing
›Pregnancy test before ionizing imaging in reproductive potential
›Urinalysis early in all urinary phenotypes
›Pelvic ultrasound early in pregnancy or torsion concern
Condition specific pathways
›Cystitis pathway
›Nitrofurantoin PO 100 mg twice daily
›Duration 5 days
›Avoid if suspected pyelonephritis
›Pyelonephritis pathway
›Ceftriaxone IV 1 g once
›Oral step down per local resistance patterns
›Blood cultures if septic physiology
›Ureteral stone pathway
›NSAID first line if no contraindications
›Tamsulosin PO 0.4 mg daily if distal stone suspected
›Urology consult if infected obstruction concern
›PID pathway
›Ceftriaxone IM 500 mg once
›Doxycycline PO 100 mg twice daily
›Metronidazole PO 500 mg twice daily
›Duration 14 days
›Reassessment
›Pain score trend every 30 to 60 minutes until controlled
›Repeat vitals after analgesia and fluids
›Escalate if new peritonitis or worsening instability