ED Assessment

PC

• 28yo F presenting with 2/7 hx of dysuria and suprapubic pain.

HPC

• Onset of burning dysuria 48 hrs ago, progressively worsening.
• Associated urinary frequency (voiding q1-2h), urgency, and mild suprapubic ache.
• Denies visible haematuria, fevers, rigors, nausea, vomiting, flank pain, or PV discharge/bleeding.
• Alert, comfortable at rest, systemically well.

PMH

• Mild asthma, previous uncomplicated UTI (2 yrs ago).
• salbutamol (Ventolin®) 100 mcg INH PRN, ethinylestradiol/levonorgestrel (Levlen ED®) 30 mcg/150 mcg PO OD.
• Cefalexin (maculopapular rash).

O/E

• Temp 36.8 °C, HR 76 bpm, BP 118/72 mmHg, RR 14/min, SpO2 99 % on RA.
• Abdomen soft, mild suprapubic tenderness on deep palpation, no guarding or rebound. Renal angles non-tender bilaterally (CVA tenderness negative).

Investigations

• Urine dipstick: Leukocytes 3+, Nitrites +ve, Blood 1+, Protein trace, Glucose -ve. Urine β-hCG -ve.

Impression

• Acute uncomplicated lower UTI (cystitis).
• Nil red flags for pyelonephritis or urosepsis.
• Midstream urine (MSU) sent for MC&S.

Outcome

• Discussed diagnosis of uncomplicated UTI and agreed on trial of oral antibiotics with outpatient management.
• Advised on adequate oral fluid intake, regular simple analgesia, and completing the full antibiotic course.
• GP f/u in 48–72 hrs if symptoms fail to improve, to review MSU sensitivities.
• Advised to return to ED if developing fevers, rigors, flank/back pain, persistent vomiting, or inability to tolerate oral fluids.

Plan

1. trimethoprim (Alprim®) 300 mg PO nocte for 3/7; paracetamol (Panadol®) 1,000 mg PO QID PRN for pain.
2. MSU sent to lab for MC&S.
3. Review with GP in 3/7 if symptoms persist.
4. Return to ED immediately if signs of upper tract involvement (fever, flank pain, vomiting) develop.