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The patient, a 66-year-old male smoker with hypertension, type two diabetes mellitus, and a prior history of nephrolithiasis. Presents with acute loosening back pain. Symptoms began yesterday after he was shoveling snow; initially manifested as gradual onset, lower back pain and flank pain, left > white, and a character similar to past episodes of renal colic. The pain suddenly was sent this morning while he was showering, and now encompasses both sides of his back and radiates mid abdomen. He states that he felt faint and nearly passed out. The pain is now characterized as severe. He remains lightheaded and reports nausea, without vomiting; denies chest pain, palpitations, dyspnea, dysuria, hematuria, change in bowel movements, Molina, hematochezia, or hematemesis. Physical exam is significant for hypertension, tachycardia, intermittent, tachypnea, secondary to pain, and pallor. He manifest, generalized abdominal guarding without localized tenderness, or palpable mass; dusky discoloration of the flank area and diminished bilateral femoral pulses.
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