Page 1 of 2: surg---RTA<abd trauma,imaging

drada · Credits: 45712 My Scrapbook My Reading List 2 Books

A 25 yr old male brought to emergency with history of road traffic accident two hours ago.The patient is haemodynamically stable .Abdomen is soft.On catheterisation of bladder,haematuria is noticed.The next step in management should be
a]immediate laprotomy
b]retrograde cystourethrography{RGU}
c]Diagnostic peritonial lavage{DPL}
d]contrast enhanced CT

sd04 · Credits: 4297 My Scrapbook My Reading List 9 Books

i will go for (b)!

sea_corel · Credits: 11991 My Scrapbook My Reading List 7 Books

me too.... ans should be (b) as pt is stable so the best next line of management should be RGU

jagatra · Credits: 900 My Scrapbook

I'm not so sure.
Wouldn't passing a catheter or a urethroscope further damage the urethra?

jagatra · Credits: 900 My Scrapbook

OOps!!!!!! My mistake!!!!!!!!!
The answer IS Retrograde cystourerthrogram

drada · Credits: 45712 My Scrapbook My Reading List 2 Books

me too thougt so,but since no evidence of urethral injury [no bleed seen at meatus],best option to assess renal injury is CT scan

drsmita_s · Credits: 18690 My Scrapbook

you r right drada,
in this case there is no urethral injury ( no blood at meatus ) , moreover , catheter is going in easily. so , no need for RGU.
there could be renal injury, so , we should go for CECT abdomen.
if the choice of ivp was given , it would have been a better answer since ivp is the inv. of choice in case renal injury is suspected.
so, the ans should be d)

asd · Credits: 851 My Scrapbook

immediate laparotomy: the patinet is stable you have time to establish an exact diagnosis and to rule out chronic etiologic factors.

RGU: Bladder has already been cathetersied. th lesion must be at a higher level

DPL: kidneys and ureters are retroperitoneal organs.

cect of abdomen shows all abdominal organs and lower pleural spaces.it is faster, easier, and more sensitive than IVP. In my opinion alternative might be an ultrasound scan.

I dont think IVP has a role in ER.

sd04 · Credits: 4297 My Scrapbook My Reading List 9 Books

DONT know may be u all r rt as it wud be more accurate but i think retrograde cystourethrography n bedrest for the pat as he is hemodynamically stable n in this kindda falls pat usually recovers(hematoma) on only bedrest for a wk or so.

correct me if im wrong....

not very sure again for this specific case otherwise i agree v cect!

sd04 · Credits: 4297 My Scrapbook My Reading List 9 Books

Excuse me....rt CECT...!agreed!

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