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Thu Mar 22 12:42:48 GMT 2007

Hi all - quick views to settle collegial argument:

(Remember- primary care setting, for all intents third world, 30 min transfer to first world academic/trauma center)

32 male pedestrian run over by minibus taxi.  GCS 15, Resp NAD, hypovolaemic but perfusing well, closed tib/fib fracture.  HR 110, BP 100/60, Sp02 99% on air.  Chest & pelvis NAD but severe abdominal bruising.  Abdomen distended, tense, becoming peritonitic. Rectal NAD.  Patient is, of course, booked for urgent transfer to trauma center.

1)  Do you catheterise this patient?
2)  Suprapubic or transurethral?
3)  If the patient is already catheterised and no urine is forthcoming (doc reports no difficulty in procedure), do you remove it?
4)  Is this presentation suggestive of bladder rupture?

I have my opinions, which were overridden by a senior colleague.  I, of course, am right, (*grin*) but need ammo.

Your thoughts?

R.
_____________________
Dr Ross Hofmeyr
MBChB (Stell) ATLS ACLS
wildmedic at gmail.com
ross at wildmedix.com
www.wildmedix.com

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