List Archives

Sat Feb 2 03:59:41 GMT 2008

A pelvic fracture stable hematuria
1. portable retrograde urethrography, if negative, then catheter into  bladder

then on to CT table

CT scanograms frontal and lateral, before, after filling with 40 ml 30%  
contrast, after emptying. if equivocal contrast extrav, then washout with saline  
then repeat frontal and lateral scannograms
Then conventional CT for poly trauma.

2. retrograde urethrography positive
 then CT scan of abdomen and pelvis
then CT guided cystostomy,
Then Cystography if necessary

B pelvic fracture, hemodynamically unstable 
OR

C. pelvic fracture hemodynamically labile, then gentle catheterization  
attempt by experienced physician, then if stabilizable, CT Scan for poly  trauma

CT can identify urethral injuries.

Clamping the foley in CT to fill the bladder is INACCURATE

Some advocate filling the bladder with 3% contrast and then do CT of  
polytrauma with bladder distended.  I DO NOT LIKE THIS.

SAL
In a message dated 2/1/2008 8:02:23 P.M. W. Europe Standard Time,  
cmursic at gmail.com writes:

(FYI:  January is Bladder Health and Injury Prevention  Month.)

Two question for the group:

1. When do you specifically  screen for bladder injuries in your
polytraumatized (blunt)  patients?

2. How do you do it?
A. CT scan.  Do you clamp  the urinary catheter first?  Do you instill
contrast into the bladder  prior to scanning?
B. Retrograde cystogram (i.e. instilling contrast via  the bladder catheter
and shooting plain films)?
C. Other?

Many  Thanks, etc.

C Ursic, MD
Santa Fe, USA

**************Biggest Grammy Award surprises of all time on AOL Music.     
(http://music.aol.com/grammys/pictures/never-won-a-grammy?NCID=aolcmp003000000025
48)

List Archives

For your convenience, find the Trauma List Archive Below

The Bladder is an Important Organ