Trauma

Question 1

What information do you want to obtain from all conscious trauma patients?

Answer 1

A.M.P.L.E. history

allergies
medications
past medical / surgical history 
last meal
events relating to the injury

Question 2

If you have to fix a low extraperitoneal bladder rupture, what is the best approach?

Answer 2

Transvesically

Question 3

Grading of renal injuries

Answer 3

Grade 1 - contusion/hematoma (subcapsular)
Grade 2 - laceration <1cm
Grade 3 - laceration >1cm but not in collecting system

Grade 4 - laceration into collecting system or pelvis or UPJ obstruction (essentially any collecting system violation) or segmental infarctions of the kidney

Grade 5 - shattered kidney or totally devascularized kidney or avulsed hilum

Question 4

In a pediatric trauma patient who has a traumatic UPJ disruption, what is proper management

Answer 4

Cysto, retrograde, stent placement.

The WRONG answer is to go to the OR

Question 5

What are the indications for imaging in a pediatric patient with blunt, non-penetrating abdominal or pelvic trauma?

Answer 5

• gross hematuria
• microscopic hematuria with shock
• a high velocity deceleration accident, a fall from >10 feet, or significant strike to abdomen
• significant trauma to thoracic organs

Question 6

What’s the recommended way to protocol a CT for trauma in a Peds patient in who you are working up possible GU trauma?

Answer 6

Single phase urographic at 10-15 minutes