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Old 09-18-2012
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Default pelvic injury

A 38-year-old man was thrown from his motorcycle
and brought to the emergency department
by emergency medical services. The paramedics
report his initial blood pressure was 83/52 mm
Hg, pulse was 128/min, and respiratory rate was
33/min. He was given 2 L of lactated Ringer’s
solution en route, and medical antishock trousers
were applied. On arrival to the trauma bay
his blood pressure is 108/76 mm Hg, pulse is
105/min, and respiratory rate is 28/min. On examination
pelvic compression elicits severe
pain, and blood is noted at the urethral meatus.
Which of the following is the most appropriate
next step in evaluating the blood at the urethral
meatus?

(A) Abdominal ultrasound
(B) Digital rectal examination
(C) Foley catheter insertion and urinalysis
(D) Intravenous pyelogram
(E) Retrograde urethrogram
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  #2  
Old 09-18-2012
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ans ......E.........
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Old 09-18-2012
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E

Never try to insert a foley catheter, that will lead you to liability and being a patient yourself cause you are gonna get stomped.
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Old 09-18-2012
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Quote:
Originally Posted by K06100 View Post
A 38-year-old man was thrown from his motorcycle
and brought to the emergency department
by emergency medical services. The paramedics
report his initial blood pressure was 83/52 mm
Hg, pulse was 128/min, and respiratory rate was
33/min. He was given 2 L of lactated Ringer’s
solution en route, and medical antishock trousers
were applied. On arrival to the trauma bay
his blood pressure is 108/76 mm Hg, pulse is
105/min, and respiratory rate is 28/min. On examination
pelvic compression elicits severe
pain, and blood is noted at the urethral meatus.
Which of the following is the most appropriate
next step in evaluating the blood at the urethral
meatus?

(A) Abdominal ultrasound
(B) Digital rectal examination
(C) Foley catheter insertion and urinalysis
(D) Intravenous pyelogram
(E) Retrograde urethrogram

E is the answer
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Old 09-18-2012
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(E) Retrograde urethrogram
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Old 09-18-2012
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The correct answer is B. Blood at the urethral
meatus suggests urethral injury. A rectal examination
can evaluate for a high-riding, ballotable
prostate, which further suggests urethral
injury. After DRE, a more defi nitive test such
as a urethrogram can be performed.
Answer A is incorrect. Although an abdominal
ultrasound may be used in the initial evaluation
of trauma, it will not provide any information
about either the pelvic fracture or the
potential for urethral injury.
Answer C is incorrect. A Foley catheter should
never be placed in a patient with suspected
urethral damage because the catheter could
increase the urethral injury.
Answer D is incorrect. An IVP does not adequately
assess urethral injury in the setting of
trauma and takes too long to obtain to be of
use in emergent situations.
Answer E is incorrect. A urethrogram is the defi
nitive study for suspected urethral injury. However,
a rectal examination should be done fi rst
as part of the rapid trauma survey to assess the
position of the prostate, as well as to assess rectal
tone and determine the presence of gross blood.
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