Evaluation and Management Flashcards
1
Q
DKA evaluation and management
A
Initial response
- Call for help
- Vitals
- Primary survey
- Bedside investigations
- Collateral hx
- Empirical management
Vitals
- Febrile
- Haemodynamically stable
- Pulse ox
Primary survey
- A
- > exclude upper airway obstruction
- B
- > kussmauls breathing
- > wheeze/crepitations (pulmonary oedema)
- C
- > evidence of shock
- > assess volume status
- D
- > serial GCS
- E
- > evidence of trauma or infective source
- F
- > colleague to gain two IV access
- > insert catheter
- G
- > BGL
- > capillary ketones (DBHB)
Investigations
- bHCG
- ECG
- VBG
- > glucose
- > high anion gap acidosis
- > K usually spuriously normal
- > pseudohyponatraemia
- CMP
- > low or normal
- Serum osmolality
- > above 300 in HHS
- FBC
- > leukocytosis
- Urea/creatinine
- > AKI
- Consider
- > blood cultures
- > urinalysis
- > CXR
Hx
- PC
- > polyuria/polydipsia
- > fatigue/weakness
- > nausea/vomiting
- > abdo pain
- Systems review for trigger
- > urinary
- > pulmonary
- > cardiac
- > GI
- Diabetes control
- > assess compliance
- > previous admissions
Management
- Goals
- > restore circulating blood volume
- > inhibit lipolysis/gluconeogenesis/ketogenesis
- > address precipitating factors
- Issues
- > acidosis
- > dehydration
- > hypo/hyperkalaemia
- > not glucose
- Fluids
- > normal saline as fast as possible
- Insulin
- > IV infusion at 0.1 units/kg/hr
- > don’t drop BGL too fast (cerebral oedema)
- > continue until acidosis/ketosis/clinical condition resolves
- Glucose
- > start 5% glucose infusion at 10-15mmol/L
- Potassium
- > supplement straight away if low
- > begin once urinary flow established
- Monitoring
- > continuous cardiac monitoring
- > regular BP
- > hourly BGL/ketones/VBG
- Education
- > review precipitating events
- > discuss symptoms and triggers of DKA
- Prevention
- > during illness/reduced fluid intake
- > when sick check BGL/ketones and maintain hydration
- > present to medical attention early
2
Q
Upper GI bleeding evaluation and management
A
Initial response
- Call for help
- > gastro/gen surg
- > blood bank/massive transfusion protocol
- Attach Vitals
- Concurrent
- > primary survey
- > hx (liver disease/varices/ulcers/emesis/medications)
- > bedside investigations
- > management
Vitals
- Hypotensive
- Tachycardia
- MAP >65
- Pulse ox
Primary survey
- A
- > caution aspiration
- B
- > determine RR
- C
- > evidence of shock
- D
- > serial GCS
- E
- > stigmata of chronic liver disease
- > acute abdomen = perforation
- F
- > gain 2x IV access
- > insert catheter
- G
- > glucose
Hx
- PC
- > haematemesis vs coffee ground
- > melena
- > dizziness/presyncope
- > angina
- > confusion
- Underlying cause
- > post emesis = MWT/BS
- > jaundice/distension = gastropathy/varices
- > epigastric pain = peptic ulcer
- > dysphagia/weight loss = malignancy
- > GORD = oesophageal ulcer
- Past hx
- > previous UGI bleed
- > known varices/liver disease/peptic ulcer/malignancy
- Meds
- > NSAIDs
- > anticoagulants/antiplatelet
- > doxycycline
- > iron/bismuth
- Social
- > alcohol
- > smoking
- > IV drug use
Investigations
- Blood group and cross match
- ECG
- VBG
- > lactate
- > Hb
- FBC
- > Hb normal early
- EUCs
- > urea:creatinine >30
- Coags
- LFTs
- Urgent upper endoscopy once stable
Management if unstable
- Secure airway
- > nasal cannula
- > low threshold for intubation
- Fluid resuscitation
- > start immediately
- Transfusion
- > consider massive transfusion protocol
- Monitor
- > cardiac monitoring/ECG’s
- > pulse ox
- > serial BPs
Management of stable patient
- Keep NBM
- Fluid rescus
- PRBs
- > restrictive (<7) approach preferred
- > lower mortality compared to liberal (<9)
- > no difference in MI/CVA/AKI
- FFP
- > give before endoscopy if INR >2
- Platelets
- > consider before endoscopy if thrombocytopaenic
- Medications
- > IV esomeprazole 80mg
- > consider IV octreotide
- > IV erythromycin 30mins prior to endoscopy
- > IV ceftriaxone 1g if cirrhotic
- > consider reversing anticoagulants/anti-platelets
- Upper endoscopy for definitive management
- > clipping/coiling
- > adrenaline
- > band ligation
3
Q
ACS management summary
A
THROMBINS2
- > Thionopyridines (clopidegrel)
- > Heparin/enoxaparin
- > RAS (ACEI/ARB)
- > O2
- > Morphine
- > Beta blocker (bisoprolol/metoprolol)
- > Invasive treatment (PCI) preferred
- > Nitoglycerine
- > Salicylate (aspirin)
- > Statin
4
Q
Epistaxis evaluation and management
A
Initial measures
- PPE
- patient bucket, towel, tissues
- patient upright and leant forward
- compress nose/blow occasionally
Severity screen
- Primary survey
- > haemodynamic instability
- > trauma
- Hypovolaemia
- > duration
- > quantity
- > syncope/presyncope/dizziness
- HTN crisis
- > headaches
- > vision changes
Hx
- Trigger
- > trauma
- > foreign body
- Site
- > which nostril did it start
- > nose (anterior) or throat (posterior)
- Sinusitis
- > pain/fever/malaise
- PHx
- > previous episodes
- > easy bleeding/bruising
- Family hx
- > bleeding disorder
- Medications
- > anticoagulants/anti-platelets
Exam
- Locate source of bleed
- > headlight/raise tip of nose/suction
Acute management
- Consider oxymetazoline 0.05%
- > spray
- > nasal pledgets x3
- Rapid rhino
- Consider topical 4% lidocaine
- Consider silver nitrate cautery
- > avoid applying to both sides of septum (blood supply)
- > apply petroleum jelly after
- If resistant
- > ENT electrocautery with lidocaine + adrenaline
Delayed management
- Packing/nasal sponge
- > saturated in petroleum jelly/antibiotics
- > leave in place for approx 24hrs
- Analgesia
- > paracetamol
- > avoid NSAIDs
- Consider antibiotics if prolonged packing
- > trimethoprim/sulfamethoxazole (s aureus)
5
Q
Psychosis evaluation and management
A
Safety
- consider use of safe room
- leave door open/clinician closest to door/don’t block
- security nearby and aware/colleagues nearby and aware
- isolation
- > allow any social supports to be present if helpful
- > avoid contacts that escalate situation
- personal objects that may cause harm
- review risk
- > notes
- > friends/family
- > colleagues
Hx
- PC
- > explore concerns
- > anxiety
- > delusions/hallucinations/reference
- > depressive symptoms/manic symptoms
- > harm to self or others
- Past psych
- > previous admissions
- > medications/doses/compliance/issues
- Past medical
- > serious illness
- Medications
- Substances
- Social
- > housing/employment/financials
- > supports/dependents
- Forensic
- > any trouble with law/police
MSE
- appearance (ungroomed/hygiene)
- attitude (guarded/hostile)
- mood/affect (anxious/angry)
- speech/thought (disordered thinking/content)
- perception (evidence of disorder)
- cognition (GP cog)
- insight and judgement (critical to assess for management)
Investigations
- VBG
- > glucose
- > electrolytes
- FBC
- > infection
- Urea/creatinine
- > baseline or meds
- LFTs
- > baseline for meds
- CMP
- TSH
- Drug screen
- Consider
- > B12/folate/thiamine
- > STI screen
- > hepatitis panel
- > ESR/ANA
- > lumbar puncture
- Once stable
- > MRI brain
- > EEG
- Anti-psychotic screen
- > BMI + BP
- > HbA1c
- > lipids
- > prolactin
- > ECG
Management
- Disposition
- > voluntary/involuntary admission
- > harm to self/others + damage to reputation
- Consult
- > early involvement of psych/drug and alcohol team
- > consider transfer to secure unit
- Aggression
- > verbal de-escalation
- > respect personal space/do not provoke
- > acknowledge concerns/feelings
- > outline what is not appropriate/acceptable
- Chemical sedation
- > only if verbal had failed
- > IM lorazepam/midazolam
- > IM haloperidol/droperidol
- > IM ketamine
- Antipsychotic
- > 0.5mg rispiridone oral or IM
6
Q
SAH evaluation and management
A
Red flags on history
- PC (SNOOP4)
- > systemic (fever/weight loss)
- > neuro (weakness/vision/dysphasia)
- > onset sudden/severe
- > onset late in life for first time
- > pattern of increasing frequency
- > precipitated by emotion/orgasm/cough
- > positional pain
- > pain in neck or eye
- Past hx
- > concurrent head infection
- > HTN
- > coagulopathy
- Family hx
- > SAH
- > strokes
- Medications
- > anticoagulants/NSAIDs
- > simpathomimetics
- Substances
- > smoking
- > high alcohol intake
- > cocaine/amphetamines
Red flags on exam
- Vitals
- > cushings triad
- > fever = inflammation or bleeding
- Altered mental status
- Focal neuro signs
- Meningismus
- Eye
- > papilloedema
- > tersons
- > red eye
- > visual deficits
- > CN IV/VI palsy
Investigations
- CT or MRI
- > non con
- > neck/cerebral angiography
- LP (if imaging negative)
- > high opening pressure = pathology
- > RBC dilution across 4 tubes/xanthochromia
- > biochemical analysis
- ECG
- FBC
- > anaemia?
- > thrombocytopaenia?
- Coags
- EUCs
- > hyponatraemia (SIADH)
Management
- Grading
- > Hunt and Hess
- Transfer
- > to ICU
- > tertiary institute
- Blood pressure
- > withold management unless severe/stuporous
- Vasospasm
- > Nimodipine 60mg oral immediately
- Analgesia
- > paracetamol
- > opioids
- Reverse/withold anti-coagulants/anti-platelets
- Maintain euvolaemia
- > prevent hypovolaemia and stroke
- > avoid raising BP
- > correct hyponatraemia
- Monitor
- > neurological status every 1-2hrs
- > transcranial doppler daily
- Definitive treatment
- > surgical clip/coiling
7
Q
Initial assessment and management shock
A
Immediately
- call for help
- resus bay
- concurrent
- > hx
- > primary survey
- > initial investigations
Search for red flags on primary survey A -patent/protected B -RR ->tachypnea early sign of shock -expansion -pulse ox C -hypotension ->SBP <90 ->MAP <65 -tachycardia (absent if compensated) -cool/clammy/cyanosed skin -delayed cap refill -auscultate chest ->lung fields ->heart sounds D -alertness/orientation E -trauma/bleeding/bruising -infection F -two large bore canals -fluid bolus ->adult = 500mL ->pads = 10mL/kg -draw blood for labs -consider catheter for fluid balance G -glucose
Risk stratified response
- life threatening condition suspected
- > begin empiric life saving therapies
- > do not delay for results lab studies
- patient stable but undifferentiated
- > focused hx and exam
- > ECG
- > CXR
- > ultrasound (RUSH) or echo
- > lab studies
Lab studies for undifferentiated
- ABG
- > hypoaemia
- > lactate
- > acidosis
- FBC
- > leukocytosis (sepsis)
- > anaemia/thrombocytopaenia (bleeding)
- EUCs
- > elevated in shock
- LFTs
- > end organ perfusion
- Coags and D dimer
- Troponin and BNP
Empiric treatment
- IV fluid boluses
- > adults = 20mL/kg up to 1L (ICU)
- > paediatrics = 10mL/kg up to 40mL/kg (ICU)
- > smaller if cardiogenic suspected
- Inotropes/pressors
- > when fluid resus failed (can worsen hypovolaemic shock)
- > pressor choice doesn’t matter
- > norad or metaraminol
8
Q
COPD exacerbation evaluation and management
A
Imminent respiratory failure on primary survey
- A
- > upper airway often mistaken for exacerbation
- B
- > resting dyspnoea
- > tachypnoea >30
- > Sp02 <90 or deteriorating if long term
- > silent chest
- C
- > cyanosis
- > cor pulmonale (JVP/oedema/cap refill)
- D
- > altered mental status
Hx
- PC
- > worsening SOB (exercise capacity)
- > cough
- > sputum increased/purulent
- > chest tightness
- Past
- > previous exacerbations and treatment
- > asthma/heart disease/AF/GORD/cancer
- Medications
- > current treatment/compliance/issues
- > corticosteroids
- > oxygen
- > previous antibiotic use
- Social
- > smoking
- > supports/dependents/proximity
- > consider need for hospitalisation
- > discuss goals of care/CPR/tracheostomy
Investigations
- ECG
- > MI as differential
- > high risk for arrhythmia
- > AF is risk factor
- VBG
- > pH <7.3
- > O2 <60
- > CO2 >50
- FBC
- > anaemia will exacerbate
- > leukocytosis in infection
- EUC
- > medication baseline
- > dehydration/shock
- CXR
- > evidence of infection
- > pneumothorax
- > cancer
- > oedema
- > effusion
- Consider
- > sputum MCS
- > blood cultures
- > spirometry once stable
Management
- Ensure adequate oxygenation
- > titrate to 88-92%
- > provide non invasive ventilation
- > continual pulse ox/reassess VBG after 30-60 mins
- Risk stratify (GOLD/NICE guidelines)
- > Mild = home + SABA
- > Moderate = home + SABA + antibiotics +- steroids
- > Severe = admit + SABA +- SAMA + antibiotics + steroids
- Salbutamol
- > MDI 8 puffs every 3 hours (or sooner)
- > nebuliser 5mg every 20 minutes on air (not O2)
- Consider ipratropium
- > MDI 6 puffs every 6 hours
- > 500mcg via nebuliser
- Corticosteroids
- > oral prednisone 50mg for 5 days
- > IV hydrocortisone if oral intolerable
- Antibiotics
- > doxycycline 100mg mane for 5 days
9
Q
Lower GI bleed evaluation and management
A
Primary survey
- concerned about relative hypotension
- assess for haemodynamic stability
- assess for peritonism
Hx
- Severity screen
- > duration/degree
- > continuous/intermittent
- > coating/mixed with stool
- > syncope/presyncope
- Additional symptoms
- > nausea/vomiting
- > diarrhoea/constipation
- > tenesmus/weight loss
- > abdo pain
- > fevers
- Past
- > IBD
- > haemorrhoids
- > diverticular disease
- Warfarin
- > dose/INRs
- > new brand/medications/supplements
- > changes to diet/alcohol/smoking
- Social
- > recent travel
- > sick contacts
- > new foods/raw/undercooked
Initial investigations
- Glucose
- VBG
- > pH
- > electrolyte
- FBC
- > anaemia
- > thrombocytopaenia
- > leukocytosis
- Iron studies
- Coags
- > PT/aPTT
- > INR
- Blood group and cross match
- Imaging for malignancy
- > CT
- > colonoscopy (needs INR >2.5 + bowel prep)
- Consider stool MSC
Initial management
- IV access
- > fluid boluses
- > analgesia
- PRBCs
- > significant drop in haematocrit
- > level <7
- Consider reversing warfarin (haematology consult)
- > vitamin K
- > FFP
- > prothrombin complex concentrate
10
Q
Bowel obstruction evaluation and management
A
Issues
- Peritonitis/perforation
- > fevers/pain with jarring movements/acute abdomen
- > CRP/WCC/lactate
- Dehydration/shock
- > hypotension/postural
- > tachycardia
- > dry appearance
- Electrolyte imbalance
- > cardiac monitoring
Hx
- Common features
- > colicky abdo pain (how/where did it begin)
- > altered bowel habits
- > nausea/vomiting
- > distension
- Severe features
- > nil flatus
- > feculent vomiting
- > fevers
- > pain with jarring movements
- Cancer
- > gradual symptoms/weight loss/bleeding
- > known malignancies/cancer syndromes
- Past hx
- > surgeries
- > crohns
- > radiotherapy
- > cancer
- Medications
- > pro constipation (iron supplementation)
Exam
- Vitals
- > fever
- > haemodynamically stable
- Appearance
- > moving/not moving
- > scars
- > hernias
- Abdo
- > distension
- > peritonism
- > mass
- > ascites
- > bowel sounds usually normal
- PR
- > impaction
- > empty vault = complete obstruction
Investigations
- Glucose
- VBG
- > pH/lactate
- > electrolyte
- FBC
- > leukocytosis
- CRP
- > ischaemia/perforation
- Urea/creatinine
- > dehydration
- Lipase
- Xray
- > obstruction
- > perforation
- CT
- > higher sensitivity for malignancy
- Endoscopy
- > assess left sided malignancy
- > diagnose/treat sigmoid volvulus
Management
- Keep NBM
- Early involvement of surgical team
- > avoids over treating/investigating
- > avoids complications
- IV access
- > analgesia (IV simple/morphine)
- > fluids
- > replace electrolytes if severe
- Gastric decompression
- > nasogastric tube/suction
- Indications for operation
- > evidence of surgical correctable cause (neoplasia)
- > peritonism/complete obstruction/ischaemia
11
Q
Evaluation and management pyelonephritis
A
Hx
- Classic triad
- > fever/chills
- > loin pain (not groin/constant not colicky)
- > nausea/vomiting
- Irritative symptoms
- > dysuria/frequency/urgency
- Stones
- > colicky loin to groin
- Shock screen
- > dizziness/syncope
- > fluid intake
- Risk factors for disease occurrence
- > sexual activity/new partner
- > recent UTI
- > diabetes
- > stress incontinence
- Risk factors for complicated disease
- > immunocompromised
- > kidney/bladder disease
- > recent catheterisation/instrumentation
Exam
- Vitals
- > tachycardia is common
- > febrile
- Evidence of sepsis/shock?
- > peripheral perfusion (cap refil/pulses)
- > cold and clammy
- Abdo
- > costovertebral tenderness
- > palpable bladder
- > abdo tenderness (complications)
Investigations
- Urinalysis
- > dipstick = leuks/nits
- > MSU for MCS
- VBG
- > lactate/pH
- > electrolytes
- FBC
- > leukocytosis
- CRP/ESR
- EUCs
- Imaging
- > consider CT/ultrasound if severe/complicated
Management
- Hospitalisation
- > unable to maintain oral intake/dehydrated
- > hypotension/shocked/septic
- > high fever/high WCC
- > complicated disease
- Severe disease
- > IV access
- > analgesia + maintenance fluids
- > monitor fluid blance/signs of sepsis
- > empirical IV gentamicin + amoxicillin
- Mild/moderate
- > empirical oral amoxicillin + clavulonate for 14 days
- > switch to targeted following culture results
12
Q
NOF evaluation and management
A
Primary survey
- C
- > hypotension
- > haemorrhagic shock
- > early ECG (arrhythmias)
- D
- > alertness/orientation
- > delirium
- E
- > shortened/externally rotated = displaced
- > ecchymoses around hip
- > external rotation/abduction/straight leg raise hip (possible?)
- > lower limb neurovascular
- > additional injuries (head/rib/wrist)
- F
- > IV access
- > fluid balance/resuss and maintenance
- G
- > early glucose (hypoglycaemia)
Hx
- Falls
- > mechanism
- > force
- > syncope/dizziness/palpitations/vision/illness
- Fracture
- > pain in hip/GT/groin/leg
- > lack of movement
- > inability to weight bear
- Past hx
- > falls/fractures
- > hip surgery
- > anaemia
- > diabetes
- > arrhythmias
- > dementia
- > vision
- > malignancy
- Medications
- > falls = sedatives/hypoglycaemics/anti-hypertensives
- > fractures = loops/PPIs/steroids/thyroxine
- > surgical risk = anti-coagulants
- Social
- > functional status
- > carer/caring
- > smoking/alcohol
Investigations
- FBC
- > anaemia as cause/surgical risk
- EUC
- > electrolytes as cause/surgical risk
- Coags
- Group and hold
- > pre-op
- Xray
- > AP = shentons line/breach of cortex
- > lateral = anterior displacement of shaft/neck from head
Management
- Early consult
- > orthopaedics
- > orthogeriatrician
- Analgesia
- > immediate/before investigations
- > paracetamol/opioid
- > femoral nerve/fascia iliaca block
- Discuss goals of care
- Surgery
- > usually same day or day after (avoids higher mortality)
13
Q
Nephrolithiasis evaluation and management
A
Issues
- Complicated ureteric colic
- > pyelonephritis
- > UTI
- Risk of sepsis
Hx
- PC
- > pain (colick vs constant/loin vs groin)
- > dysuria/frequency/urgency
- > nausea and vomiting
- > dizziness/syncope
- > fluid intake
- > urine output
- Differentials
- > change in bowel habits
- > blood/mucus in stool
- > known ovarian cysts
- Risk factors for complicated disease
- > previous stones
- > immunocompromised
- > kidney/bladder disease
- > recent catheterisation/instrumentation
Exam
- Vitals
- > febrile
- > haemodynamically stable
- Assess for evidence of shock
- Determine volume status
- Costovertebral tenderness
- Abdo
- > tenderness (ddx)
- > palpable bladder
Investigations
- bHCG
- Urinalysis
- > dipstick = leuks/nits
- > MSU for MCS
- VBG
- > lactate/pH
- > electrolytes
- FBC
- > leukocytosis
- CRP/ESR
- EUCs
- > AKI
- CMP
- Uric acid
- Blood cultures
- Imaging
- > xray + CT KUB (colic picture)
- > ultrasound preferred (reproductive age)
Management
- Admit
- > high risk for sepsis
- Urgent urology review
- IV access
- > adequate analgesia (NSAIDs have good evidence)
- > anti-emetic
- > maintenance fluids
- Empirical antibiotics
- > IV gentamicin + amoxicillin
- > switch to targeted/swab cetriaxone for gent after 72hrs
- > total course (oral + IV) = 14 days
- Monitor
- > fluid balance/kidney function
- > electrolytes
- > signs of sepsis/shock
- Stone
- > surgical intervention indicated due to complication
- > laser lithotripsy + stent
- > extracorporeal shock wave lithotripsy
- > percutaneous nephrolithotomy for large proximal stone
- Mild
- > trimethoprim/sulfamethoxazole oral
- > small stone = tamsulosin for 1 month
14
Q
Evaluation and management urinary retention
A
Hx
- PC
- > details of retention
- > overflow incontinence
- Cause
- > BPH = FUNWISE
- > cancer = weight loss/fatigue/bone pain
- > colic = pain/fevers/haematuria
- > spinal = trauma
- Complications
- > sepsis = fevers/dizziness/syncope
- > electrolytes = palpitations/weakness
- > acidosis = SOB
- Past
- > BPH/prostate cancer
- > stones
- > neuro/spine disorders
- > bladder dysfunction
- Meds
- > anticholinergics
- > opioids
- > α agonists
Exam
- Vitals
- > fever
- > haemodynamically stable
- Cognition
- > alert/oriented
- > delirious
- Assess volume stasis
- Systems review
- > source of infection
- Abdo
- > palpable bladder
- > suprapubic dullness to percussion
- > constipation
- DRE
- > rubbery enlargement vs hard and nodular
- > faecal impaction
Investigations
- ECG
- > hyperkalaemia
- VBG
- > glucose
- > electrolytes
- > lactate
- Urea/creatinine
- > U:C >2 supports pre-renal
- Bladder scan/formal ultrasound
AKI management (STOP)
- Sepsis
- > blood cultures +
- > IV access/fluids/antibiotics
- Toxins (cease nephrotoxic meds)
- > NSAIDs/ARBs/ACEI
- > aminoglycosides
- Optimise fluid status/BP
- > insert catheter/check for kink
- > trial fluid bolus 250-500mL
- > consider ceasing diuretic/anti-hypertensive
- Prevent harm
- > treat hyperkalaemia
- > treat acidosis
- > monitor for APO (over treatment)
- Dialysis (AEIOU)
- > refractory metabolic acidosis
- > refractory hyperkalaemia
- > severe poisoning
- > refractory fluid overload
- > uraemia with end organ impairment
15
Q
Renal trauma evaluation and management
A
Primary survey focused on circulation and exposure
- Rationale
- > mechanism of injury requires significant force
- > damage to renal vessels common
- > damage to surrounding viscera common
- C
- > hypotension/tachycardia
- > cap refil/cold clammy
- > lower limb pulses
- D
- > change in mental state
- > concussed
- E
- > ecchymoses
- > flank pain
- > rib fractures
- > spinal tenderness
- F
- > monitor balance strictly
Hx
- PC
- > mechanism
- > force
- > quality and duration bleeding/any clots
- > additional injuries (head)
- > dizziness/syncope
- Past
- > underlying kidney disease
- > past abdominal surgery
Investigations
- Urinalysis
- > dipstick
- > microscopy
- FBC
- > haematocrit
- EUCs
- > eGFR usually normal (compensated)
- FAST scan
- Xray
- > chest for rib fracture
- > pelvis for pelvic fracture
- CT with contrast
- > sub capsular haematoma
- > laceration
- > peri-renal haematoma
- > urine leak/rupture of pelvis
Initial management
- Conservative management if stable
- Admit for monitoring
- > repeat haematocrit/EUCs
- > repeat CT after 2-3 days
- > fluids/urine output (avoid catheter until uro approves)
- Keep nil by mouth
- IV access
- > fluid resuss
- Early urology/trauma/nephrology consult
- Analgesia
- Interventions
- > angioembolisation
- > explorative laparotomy if unstable/severe CT grade
