GU_Trauma - Genitourinary Trauma François Dufresne McGill...

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Unformatted text preview: Genitourinary Trauma François Dufresne McGill Emergency Medicine February 13 th 2002 The Case of Jeremy • 23 y.o male • Driver, Seatbelted • Frontal Impact, High Speed ( 2245 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. O 2 Sat N. No crepitus. Trachea central. • C: BP:100/60 HR:100 Mentating well. • D: GCS=15 PERL. • Pt is exposed. • O 2- 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 – Kidney – 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 Andrich DE et al. The nature of urethral injury in cases of pelvic fracture urethral trauma . Journal of Urology. 165(5):1492-5, 2001 May. Anatomy Bladder Symphysis Prostatic Membranous Bulbous Pendulous Posterior Urethra • Violent external force • Pelvic # in 2245 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 examination. Digital Rectal Exam in Trauma • Porter et al. Am Surg , 2001. – Prospective – Level II Trauma Center. – 423 patients. – DRE on all. – 7 (1.7%) pelvic fracture. NO Urethral injury – Prostate exam didn’t change management Porter, J.M. et al. Digital rectal examination for trauma: does every patient need one? Am Surg 67(5):438, May 2001. Posterior Urethral rupture From McAnich JW. In Tanagho EA, McAninch JW, editors: Smith’s general urology, ed 14, Norwalk, Conn, 1995, Appleton & Lange. Diagnosis:...
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GU_Trauma - Genitourinary Trauma François Dufresne McGill...

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