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Thu Mar 22 14:03:56 GMT 2007

Hello Ross,
I think that you are only wasting time with the catheter issue, with no
benefit, only delaying more definite and appropriate treatment for more
urgent pathology.
Peter

-----Messaggio originale-----
Da: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
Per conto di Dr Ross Hofmeyr
Inviato: giovedì 22 marzo 2007 13.43
A: TRAUMA-L
Oggetto: To catheterise or not to catheterise...

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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