6.1 Flashcards
What are the two major causes of blunt injury?
blow to abd, flank, rib
rapid deceleration
What are some S/S of renal trauma?
Hypotension/shock, hematuria, echhymosis, tenderness,
At what BP is a pt considered stable?
sBP>90mmHg and stable serial Hemoglobin
How many grades of renal trauma are there? Which ones are considered major and which minor? Which are stable?
5; Minor: 1 and 2; Major 3, 4,5
Stable = 1, 2, 3.
Whats consists of a grade 1 trauma?
Gr I:
- Contusion OR
- Contained subcapsular hematoma
Whats consists of a grade 2 trauma?
Gr II:
- Nonexpanding, confined perirenal hematoma OR
- Cortical laceration less than 1 cm deep without urinary extravasation
Whats consists of a grade 3 trauma?
Gr III:
-Laceration more than 1 cm into cortex without extravasation
Whats consists of a grade 4 trauma?
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
Whats consists of a grade 5 trauma?
Gr V:
- Thrombosis of main renal art OR
- Multiple major lacerations [“shattered kidney”] OR
- Avulsion main vessel
What are the two kinds of bladder injury?
Intraperitoneal (30%) and Extraperitoneal (60%)
How are the two kinds of bladder injuries managed?
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)
What are two complications of intraperiotoneal and extraperitoneal injuries to the bladder (each 2)?
Intra: delayed peritonitis, renal failure
Extra: Hemorrhage, pelvic abcess/hematoma, urinary incontinence
Whats the difference between a posterior and anterior urethral trauma?
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
How does one manage a anterior or posterior urethral injury?
Posterior- Traditional = suprapubic tube and delayed urethroplasty. New primary alignment over catheter
Anterior: contusion- urethral catheter. Straddle- SP catheter and delayed repair, Penetrating- surgery.
What’s an important rule when tx posterior injuries?
DO NOT ATTEMPT MEATAL CATHETER IF BLOOD AT MEATUS. (also dont do meatal catheter for straddle injuries).
Give the classic Hx, PE and management and eval for penile fracture
Hx = Mechanism, audible “pop”, rapid detumescence/pain PE = Penile ecchymosis, swelling, possible abnormal angulation away from injury. Eval - US or MRI Manage w/ surgery.
What are the classic signs of extravasation/hematoma of a posterior vs anterior urethral trauma?
Posterior- Suprapubic/hematoma
Anterior- Perineal ecchymosis in Butterfly distrib
