List Archives

Thu Mar 22 17:33:02 GMT 2007

Ross,
> - snip - 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.
>   
As always, it depends... Do you do routine ultrasound your patients?
Bladder filled? Empty bladder + free fluid -> suggestiv for bladder rupture.
> 1)  Do you catheterise this patient?
>   
Yes.
> 2)  Suprapubic or transurethral?
>   
transurethral (quick US mandatory, done by surgery at the bedside)
> 3)  If the patient is already catheterised and no urine is forthcoming (doc reports no difficulty in procedure), do you remove it?
>   
No. A drop of dye in the catheter under fluoroscope / x-ray tells you more.
> 4)  Is this presentation suggestive of bladder rupture?
>   
Not necessarily.

Please report the findings.

Cheers!

Mathias

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