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Thu Mar 22 16:14:37 GMT 2007

Tim,
I couldn't agree with you more!
Ron

>>> "Hardcastle, Tim, Dr <tch at sun.ac.za>" <tch at sun.ac.za> 3/22/2007 11:29 AM >>>
Ross

Should have gone to Trauma Centre directly - or did he walk to you? Surely Metro-EMS or other should have been on scene? Provincial protocol directs these direct to GSH or TBH????

If there is no frank blood and the pelvis appears stable there is NO reason to not catheterise prior to transfer if time permits: you can then at least monitor output.

If the catheter goes in easily and no urine comes out - either: a bladder rupture or the catheter is not in right or the patient is more shocked than you thought and needs to be transferred more urgently. Again - this patient should not be at a CHC!

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za 
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Dr Ross Hofmeyr
Sent: Thursday, March 22, 2007 2:43 PM
To: TRAUMA-L
Subject: To catheterise or not to catheterise...
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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To catheterise or not to catheterise...