Quote:
Originally Posted by Red Flag 1
Usual initial priorities. Questions to answer include: ebl enroute, how much active bleeding in trauma bay, can the bleeding be controled by direct pressure, is there normal anal sphincter tone, is blood being passed out the urethera, any rectal bleeding, is the patient hemodynamically stable?
Two large bore IV's, pelvis films, soft tissue studies if possible. This needs to be explored in the OR. Is this the time to try to pass an indwelling uretheral cath? Said cath can help with hemostasis if needed IMHO. Do have some concerns with bone frags if the projectile impacted any bone. Prostate, bladder and bowel issues need to be considered as well as pelvic vascular structures.. If there is much prostate damage, there could well be significant bleeding in the pelvis that could go undetected.....could see quite a bit of blood loss in surgery as well.
As for long term outcome, we do know from a celebrated case a decade or so ago, that the appendage can be re-attached after complete amputation. From the photos, the appendage does not look cyanotic and likely viable. Physiological function and reproductive abilities likely best determined in surgery and with post-op outcome, more than a bit out of my specialty here.
As for mechanism of injury....I doubt it will happen again with this solider.
Interesting professional subject.
My $.02.
RF 1
|
Agree with usual priorities. There was some blood loss en route (about a unit of blood but the bleeding stopped by arrival. Subsequent wash-out was necessary but little bleeding was encountered. Did not stitch up the wound and left it open as did not want to trap infection (did give antibiotics). Sphincter tone was normal with rectal examination. No blood was seen at the meatus and keeping careful watch to not cross contaminate, the blood was soaked up and pressure held to the perineal wound with the rectal examination. There was no blood found on rectal exam. The patient was hemodynamically stable at all times.
He was hemodynamically stable, pelvis films will be shown below. We did not need to explore as it turned out because the CT with IV and rectal contrast and delays were negative. We did need a retrograde urethrogram (RUG) however to assure the urethra was okay. An indwelling Foley can be passed only after the RUG and no urologist was needed. The CT helped us in regards to looking at the bone fragments, vascular injuries and soft tissues including the bowel.
The Bobbitt case (replant of the penis) has been repeated many times in the US. Most of the urogenital trauma in war zones are not simple lacerations or simple amputations and are more in line with severe debulking trauma or complete loss of the penis and/or testicles. Blast injuries with the directed force straight into the groin can be devastating and typically nothing to replant and unfortunately just debridement and dressing changes. His outcome is actually favorable in the case.
DD