TRAUMA

Question 1

GR1 renal trauma management

Answer 1

urinalysis and BP measurements at 1 week; if ok discharge

Question 2

GR2 renal trauma management

Answer 2

restrict activities for 6 weeks

UA and BP measurements at 6 weeks; if ok discharge and no further imaging

Question 3

GR 3, 4, and 5 renal trauma management

Answer 3

Restrict activities for 6 weeks
UA and BP measurements at 6 weeks ALONG WITH IMAGING!
if persistent hematuria consider cysto

Question 4

Page kidney

Answer 4

Page kidney subcapsular or perirenal process causing renal ischemia with hypersecretion of renin - can alter perfusion and excretion. Long-term, an encasing fibrous pseudocapsule may form around the kidney and cause persistent hypertension despite resolution of the fluid collection. In the acute setting after renal trauma, antihypertensive therapy is useful. if the collection does not resolve then intervention (drainage) is warranted when there are associated symptoms and/or hypertension.

Question 5

scrotal blunt trauma - hematocele is associated with..

Answer 5

testicular rupture 80%

Question 6

low velocity handgun shot to perineum, 1cm disruption distal bulb

Answer 6

Most penetrating wounds to the genitalia are due to gunshots and most require surgical exploration. Treatment principles include immediate exploration, copious irrigation, excision of foreign matter and debridement of devitalized tissue, antibiotic prophylaxis, and surgical closure. Short injuries to the anterior urethra are best managed with primary repair. Injuries to the bulbar urethra can also be managed by primary repair with low-velocity gunshot wounds. The penile skin is degloved and the extent of the injury is determined. Primary anastomosis can be accomplished with short defects and low-velocity injuries. Patients with urethral injury and extensive tissue damage from high-velocity weapons or close range shotgun blasts may require staged repair and suprapubic urinary diversion. Urinary diversion alone will generally result in urethral stricture and/or fistula requiring secondary repair.

Question 7

foot drop

Answer 7

injury to common peroneal nerve - (fibula)
sciatic nerve is tibial + common peroneal nerve (separate in lower thigh) - sciatic nerve deals with flex of hip and knee; tibial nerve injury rare b/c in popliteal fossa (paralysis of flexor of leg; can’t plantar flex)

Question 8

ilioinguinal

Answer 8

L1 - innervates scrotum/labia and AM thigh (sensory); blocks though can hit femoral nerve and cause LE paralysis