Genitourinary Trauma
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 13 November 2016
⏱️ 10 minutes
🧾️ Download transcript
Summary
Four important injuries. Four different imaging studies to obtain.
Step 1: Obtain Pelvic X-Ray
* Commonly performed at bedside as part of initial trauma evaluation* A pelvic injury significantly increases risk of GU injury
Step 2: Examine the Perineum
* Common signs of GU injury* Blood at urethral meatus* Bruising of the perineum
Step 3: Obtain Urinalysis
* Gross hematuria is the red flag* Can be identified at bedside* Importance of microscopic hematuria uncertain* If you decided to send a formal urinalysis…* Patient needs follow up on the hematuria until resolved
Step 4: Consider the FOUR Genitourinary Injuries
* Kidney injury* Evaluate with CT scan abdomen/pelvis with IV contrast* Occur in approximately 10% abdominal trauma* Flank pain* Lower rib trauma* Ureteral injury* Evaluate with delayed CT scan abdomen/pelvis with IV contrast* Call radiology to help choose right imaging protocol* RARE injury* Sometimes seen with penetrating trauma or surgical injury* Frequently needs surgical repair* Bladder injury* Evaluate with retrograde cystogram* Occurs when patient with distended bladder has direct impact to low abdomen* Urethral injury* Evaluate with retrograde urethrogram (RUG)* TWO subtypes* Posterior injury* Occur with pelvic fractures* Anterior injury* Occur with straddle-type injuries
Additional Reading
* The Importance of the RUG (Taming the SRU)* Genitourinary Trauma (emDOCs)
Transcript
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| 0:00.0 | Hello, med students. My name is Zach Olson, and thank you for downloading this episode of the EM Clerkship Podcast. |
| 0:11.3 | Let's keep talking trauma. We're almost done. Here's this week's case. |
| 0:26.6 | Okay, everyone, this is Tyler. He's a 17-year-old male involved in a skateboarding accident. It's going to be a straddle-type mechanism. The folks on scene said he came down, full body weight right onto the rails, right onto the drawing area. |
| 0:34.6 | There was no LLC. Guests complain in bilateral risk pain, but no deformities |
| 0:40.3 | were noted. No head or neck complaints, no altermentation, and no LOC. BP we had was 120 over 60 |
| 0:49.3 | He volts 100. Respirations is 16, clear or equilaterally. Leuco coastal 120, GCS-50 in the whole time, |
| 0:56.5 | and if you can let them know that security has the skateboard. |
| 0:59.9 | It's in two pieces. |
| 1:03.4 | Yeah, okay. |
| 1:10.7 | This week, we're covering genital urinary trauma. |
| 1:14.2 | So much attention gets paid to head trauma and the chest injuries and abdominal injuries |
| 1:18.4 | that by about this time we stop studying and we don't learn GU trauma. |
| 1:25.2 | But this stuff is so important. |
| 1:27.7 | It's really common and can cause lots of long-term morbidity, if not treated appropriately |
| 1:33.0 | up front. |
| 1:34.3 | So stick with me today. |
| 1:35.6 | We are going to learn GU injuries. |
| 1:40.0 | And the most important thing that I want you to remember is four injuries, four imaging studies. |
| 1:47.6 | That's right. |
| 1:48.2 | Four different imaging studies today. |
| 1:50.8 | Each one is paired with a different GU injury. |
| 1:53.9 | So let's get started. |
... |
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