6.1

Question 1

What are the two major causes of blunt injury?

Answer 1

blow to abd, flank, rib

rapid deceleration

Question 2

What are some S/S of renal trauma?

Answer 2

Hypotension/shock, hematuria, echhymosis, tenderness,

Question 3

At what BP is a pt considered stable?

Answer 3

sBP>90mmHg and stable serial Hemoglobin

Question 4

How many grades of renal trauma are there? Which ones are considered major and which minor? Which are stable?

Answer 4

5; Minor: 1 and 2; Major 3, 4,5

Stable = 1, 2, 3.

Question 5

Whats consists of a grade 1 trauma?

Answer 5

Gr I:

• Contusion OR
• Contained subcapsular hematoma

Question 6

Whats consists of a grade 2 trauma?

Answer 6

Gr II:

• Nonexpanding, confined perirenal hematoma OR
• Cortical laceration less than 1 cm deep without urinary extravasation

Question 7

Whats consists of a grade 3 trauma?

Answer 7

Gr III:

-Laceration more than 1 cm into cortex without extravasation

Question 8

Whats consists of a grade 4 trauma?

Answer 8

Gr IV:

• Laceration through the corticomedullary junction into collecting system, +/- laceration at a segmental vessel OR
• Thrombosis of a segmental renal artery and corresponding parenchymal ischemia

Question 9

Whats consists of a grade 5 trauma?

Answer 9

Gr V:

• Thrombosis of main renal art OR
• Multiple major lacerations [“shattered kidney”] OR
• Avulsion main vessel

Question 10

What are the two kinds of bladder injury?

Answer 10

Intraperitoneal (30%) and Extraperitoneal (60%)

Question 11

How are the two kinds of bladder injuries managed?

Answer 11

Intraperitoneal- Expedited surgical repair w catheter drainage
Extraperitoneal-Catheter drainage alone 10-14d if uncomplicated.
Open repair with catheter drainage if complicated:
(Boney spicules, vaginal/rectal laceration, bladder neck injury, undergoing surgery for other injuries, Non-healing after 4 weeks)

Question 12

What are two complications of intraperiotoneal and extraperitoneal injuries to the bladder (each 2)?

Answer 12

Intra: delayed peritonitis, renal failure
Extra: Hemorrhage, pelvic abcess/hematoma, urinary incontinence

Question 13

Whats the difference between a posterior and anterior urethral trauma?

Answer 13

Posterior- at or above membranous urethra (relatively fixed but susceptible to shears), usually because of pelvic fracture/trauma

Anterior- penile or bulbar urethra. caused by blunt (straddle injuries, crush), penetrating, self-instrumentation, iatrogenic

Question 14

How does one manage a anterior or posterior urethral injury?

Answer 14

Posterior- Traditional = suprapubic tube and delayed urethroplasty. New primary alignment over catheter

Anterior: contusion- urethral catheter. Straddle- SP catheter and delayed repair, Penetrating- surgery.

Question 15

What’s an important rule when tx posterior injuries?

Answer 15

DO NOT ATTEMPT MEATAL CATHETER IF BLOOD AT MEATUS. (also dont do meatal catheter for straddle injuries).

Question 16

Give the classic Hx, PE and management and eval for penile fracture

Answer 16

Hx = Mechanism, audible “pop”, rapid detumescence/pain
PE = Penile ecchymosis, swelling, possible abnormal angulation away from injury. Eval - US or MRI Manage w/ surgery.

Question 17

What are the classic signs of extravasation/hematoma of a posterior vs anterior urethral trauma?

Answer 17

Posterior- Suprapubic/hematoma

Anterior- Perineal ecchymosis in Butterfly distrib