Page 1 of 2: Trauma & Oliguria

HANNA · Credits: 1064256 My Scrapbook

Theme: Trauma & Oliguria

Options
A Percutnaeous nephrostomy
B Suprapubic cystostomy
C Urethral catheterization
D Blood transfusion
E Fluid challenge
F 500-ml of IV mannitol
G Walk around

Instructions
For each of the patients below, choose the most appropriate option from the list of Options above. Each option may be used once more than once or not at an.

811 Following an elective herniorrhaphy, a 67-year-old man is unable to pass urine, when a nurse hands him a small bottle for microscopic studies. He is otherwise well.

812 A 34-year-old woman presents with right-sided loin pain & oliguria. An intravenous urogram shows right-sided dilated calyces and hydroureter.

813 A man involved in a mining accident presents with oliguria & passing dark brown urine.

814 A 45-year-old man sustained a pelvic fracture & now presents with oliguria, pulse rate of 120-beats/min & BP-70/50-mmHg.

815 A 23-year-old man who sustained a pelvic fracture is unable to pass urine. O/E he has abdominal tenderness & fullness & blood on the urethral meatus.

sajida · Credits: 105407 My Scrapbook My Reading List 6 Books

1--g
2--a
3--e or f
4--d
5--b

HANNA · Credits: 1064256 My Scrapbook

813 A man involved in a mining accident presents with oliguria & passing dark brown urine.
>>>>>..I THINK WE AGREED F BEFORE ON THIS QUESTION (OSMOTIC DIURESIS)

Satman · Credits: 2622 My Scrapbook My Reading List 5 Books

AGREE .. but for 813 .. ??? no idea ..

tania · Credits: 6560 My Scrapbook

5.y not try cathetersation

yes we agreed on osmmotic diuresis

HANNA · Credits: 1064256 My Scrapbook

because urethra is injured even if it is a pratial rupture........trying to put a catheter will make it complete and danger of going outside bladder and to the peritoneum.

so rule is not to even try a catheter in case of suspected rupture urtra.....rather go for suprapubic cystostomy.

sajida · Credits: 105407 My Scrapbook My Reading List 6 Books

b/c presence of blood on uretheral meatus ,we should not try catherisation

Drstanilo · Credits: 18038 My Scrapbook My Reading List 18 Books

But why osmotic diuresis for question 813. Couldsomeone please explain.....?

mony · Credits: 279 My Scrapbook

Drstanilo · Credits: 18038 My Scrapbook My Reading List 18 Books

Thanks Mony but still a bit confused, in acute renal failure secondary to rhabdomyolysis, line of management is often:

Large volumes of fluid up to 12L/d
IV mannitol or urinary alkalinization; see OHCM6 pg 281. Don't you think fluid challenge should be a better option in this case?

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