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Fri Mar 23 13:46:15 GMT 2007

Hello Ian,
if the transfer takes a little longer no great harm would come if he dosen't
urine. If the abdomen is TENSE AND PERITONITIC further delays are really
uncalled for, the patient needs to be in a centre were further
investigations can be done, if necessary, and appropriate surgical therapy
carried out.
Peter

-----Messaggio originale-----
Da: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
Per conto di Ian Philbrick
Inviato: giovedì 22 marzo 2007 15.21
A: Trauma &amp; Critical Care mailing list
Oggetto: Re: To catheterise or not to catheterise...

Hi Ross,

 From the point of view of an ALS Paramedic who might be called upon to 
transport similar patients, I would consider a catheter essential. 
Although you say the transfer will take 30 minutes, it invariably takes 
longer what with response times to your hospital, packaging for 
transfer, the trip, handing over (which can take a very long time 
especially at provincial hospitals). During this time the patient may 
need to urinate. Very difficult in the back of an ambulance with its 
limited space, especially as you have to move the patients legs etc to 
gain access, causing pain and possibly further damage to the fractured 
limb. To have the patient urinate on himself will be unprofessional, may 
cause contamination of any wounds he might have and create an unpleasant 
smell for the patient and attendant during the journey.

I am not dictating in any way what kind of catheter is needed, but feel 
patients being transferred in this condition should be catheterized one 
way or the other.

I see that you did not mention whether the patient had a NG tube, 
something else I would like to have placed before transfer in patients 
with these or worse injuries.

Regards,

Ian Philbrick

>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
>--
>trauma-list : TRAUMA.ORG
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>
>  
>

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