Trauma Flashcards
what is class 1 kidney trauma?
Haematoma, subcapsular, non-expanding, no parenchymal laceration
what is class 2 kidney trauma?
laceration <1cm, parenchymal depth without urinary extravasation
what is class 3 kidney trauma?
> 1cm depth, no collecting system rupture or extravasation
what is class 4 kidney trauma?
laceration through cortex, medulla and collecting system
main arterial/venous injury with contained haemorrhage
what is class 5 kidney trauma?
shattered kidney, avulsion of hilum, devascularisation kidney
what are the causes of kidney trauma?
o Penetrating – gunshots, stab wounds
o Blunt – rapid deceleration, blow to flank
o Iatrogenic – extracorporeal shockwave, renal biopsy
o Intraoperative – diagnostic peritoneal lavage
o Other – renal transplant rejection, childbirth
what is the imaging used in kidney trauma?
CT
what are the indications for CT in kidney trauma?
o Frank haematuria in adult
o Frank or occult haematuria in child
o Occult haematuria in child
o Penetrating injury with any degree of haematuria
what is the management for kidney trauma?
o Most non-operatively
o Surgery – urinary extravasation or injury staging
what are the causes of bladder trauma?
o Blunt, penetrating, iatrogenic trauma
o Commonly associated with pelvic fracture
what is bladder contusion?
incomplete or partial thickness tear of bladder, produces haematoma
what is extra peritoneal bladder rupture?
coincides with pelvic fracture = deceleration, fracture of the anterior pubic arch
what are the clinical features of bladder trauma?
o Suprapubic tenderness, lower abdominal bruising, guarding/rigidity, diminished bowel sounds
o In catherization gross haematuria present
how is bladder trauma diagnosed?
CT cystography – extra peritoneal injury will have flame shaped collection in pelvis
what is the initial management of bladder trauma?
Large bore catheter antibiotics, repeat cystogram in 14 days
what are the indications for immediate repair in bladder trauma?
Intraperitoneal injury, penetrating injury, inadequate drainage or clots in urine, bladder neck, rectal or vaginal inury, open pelvic fracture, bone fragments
what are the causes of urethral trauma?
o Blunt – blow to bulbar segment = straddling an object
o Penetrating – gunshot, stab wounds
o Iatrogenic – catheterisation
what are the clinical features of urethral trauma?
blood at meatus, inability to urinate, palpably full bladder, high-riding prostate, butterfly perineal haematoma
how is urethral trauma diagnosed?
retrograde urethrogram
what is the management of urethral trauma?
suprapubic catheter, delayed reconstruction after 3 months
what are the causes of penile fracture?
vaginal intercourse, aggressive masturbation
what is the pathophysiology of penile fractures?
Tunica albuginea layer is violated – tear in this larger leads to extrusion of the seminiferous tubules and allows an intra-testicular haemorrhage to escape into the tunica vaginalis
what are the clinical features of penile fractures?
cracking or popping sound, pain, rapid detumescence, discolouration and swelling
what is the management of penile fracture?
prompt exploration and repair, circumcision incision with degloving of penis to expose 3 compartments
