江苏省等学校大学生实践创新训练.pptVIP

Genitourinary Trauma Fran?ois Dufresne McGill Emergency Medicine February 13th 2002 The Case of Jeremy 23 y.o male Driver, Seatbelted Frontal Impact, High Speed (? 100Km/h) Airbag + Other driver dead Car completely destroyed Empty EtOH bottles in the OTHER car Patient was conscious at the scene. On scene: BP=85/50 HR:120 RR:22 Sat:98% Jeremy… A: Clear. C-spine protection. Backboard+ B: A/E symetric. O2 Sat N. No crepitus. Trachea central. C: BP:100/60 HR:100 Mentating well. D: GCS=15 PERL. Pt is exposed. O2 - iv – monitor Temperature N Capillary Glucose N Jeremy AMPLE C/O abdo. Pain + “hip” pain C/O right lower leg pain Secondary Survey Spleen normal. Mild suprapubic tenderness. Pelvic instability Probable right tibial # No gross blood at meatus. Rectal Normal. “Doctor, can I put a Foley?” Jeremy What are your concerns? Foley? What will be the usefulness of dipstick? Dipstick good enough? U/A? What if he has microscopic hematuria? What if he has a pelvic fracture? Any different if you had blood at meatus? Urethrogram? Cystogram? Abdominal CT? Worried about the kidneys? Bladder? Does the low BP changes your suspicion for a GU injury? Introduction GU Trauma overlooked 10-20% of all injured patients Long term morbidity Impotence Incontinence Life-threatening injuries first Plan Urethral Injury Bladder Injury Hematuria in Trauma Kidney Injury Definitions Upper tract Kydney Ureters Lower tract Bladder Urethra External genitalia Urethral Trauma Almost exclusively in male Significant morbidity Stricture Incontinence Impotence If unrecognized: Converting partial to complete tear Inaccurate assessment of U/O Foley catheter implication Anatomy Posterior Urethra Violent external force Pelvic # in ? 90% Pelvic # : 5-25% of Posterior urethral injury Clinical Features Gross hematuria in 98% Inability to void Blood at urethral meatus Pelvic / suprapubic tenderness Penile / scrotal / perineal hematoma Boggy / high-riding prostate/ ill-defined mass on rectal