Not Bored Review 9/2/14

by andygrock • September 2, 2014 • Comments Off

Male hipster presents – bicyclist struck. He is 22 years old, lives in Williamsburg, and arrives wearing really tight pants and an ironic mustache. He reports pelvic pain and reports he fell off the seat onto his handlebars. He reports feeling “devo” about how “totes hard” he hit his groin (see link here for translation, though these are probably already outdatedly unhip).

Take a guess at the diagnosis.

Urethral Injury

Name 5 physical exam findings?

Blood at the external urethral meatus, high riding prostate, “butterfly” perineal hematoma, scrotal hematoma, gross hematuria

What do you probably not want to do?

Put in a Foley.

Why?

You can accidentally insert the foley into the tear making…everything worse.

What if you already put it in?

LEAVE IT IN! As long as urine is coming out/it’s working.

What would you find on physical exam if the patient was a woman with the same injury?

Vaginal Bleeding

Diagnose by?

Retrograde urethrogram – “gently” put 20-30 ml of contrast in the urethra and shoot an X-Ray

Treatment?

After evaluating for life-threatening injuries, Tininalli’s recommends: supra-pubic cath with urgent (not emergent) surgical repair. Per “Trauma, 11th ed”, GU can put a fiberoptically placed foley, or attempt “gentle” foley placement. DON’T put the foley in yourself

By Dr. Andrew Grock and Dr. Sally Bogoch

Reference
Tintinalli’s 7th ed

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.

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andygrock

Resident Editor In Chief of blog.clinicalmonster.com.
Co-Founder and Co-Director of the ALiEM AIR Executive Board - Check it out here: http://www.aliem.com/aliem-approved-instructional-resources-air-series/
Resident at Kings County Hospital