Quote:
Originally Posted by wook
Vascular injury would be a concern, as would urethral tear. At some point early on I would do a RUG (Retrograde UrethroGram). If tear and no urologist to place the foley, probably try gentle placement of a foley (debate recently in literature about this). Obtain pelvic xray. I would probably also obtain CT pelvis (IV contrast). Also, concern for testicular injury...this can be evaluated by urologist ASAP (ie transfer). Get the rainbow (CBC, BMP, PT/PTT/INR, T&S). Also, a rectal exam would be helpful to see if gross blood (concern for injury of the GI tract/colon). Two large bore IV, O2, monitor.
Regarding amputation, advise him further studies are needed to fully evaluate the extent of the injury.
Wook
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Yes. The worry was that he had a deep pelvis bleed or rectal injury but the trajectory through the soft tissues on CT did not show intra-abdominal of vascular injury. Rectal, PO and IV contrast were used. He was very fortunate. Again, I will post the RUG and then we placed a Foley once we had confirmation of no urethral injury. Testicles were not involved and there did not appear to be a blast effect. Again, no gross blood on rectal and good sphincter tone. Agree, two large bore IV's and O2 if available. Monitors are great if available like here in the states but not always available in theater.
DD