Emergency Management of Renal and Genitourinary Trauma: Best Practices Update (Trauma CME)
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Emergency Management of Renal and Genitourinary Trauma: Best Practices Update (Trauma CME) -

Publication Date: August 2017 (Volume 19, Number 8)

CME: This issue includes 4 AMA PRA Category 1 Credits™; 4 ACEP Category I credits; 4 AAFP Prescribed credits; and 4 AOA Category 2 A or 2B CME credits

Whitney K. Bryant, MD, MPH, MEd
Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
Sanjay Shewakramani, MD, FACEP
Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
Peer Reviewers
Suzanne Bryce, MD
Assistant Professor, Assistant Program Director, Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
Nadia Maria Shaukat, MD, RDMS, FACEP
Director, Emergency and Critical Care Ultrasound, Department of Emergency Medicine, Coney Island Hospital, Brooklyn, NY
Emergency Trauma Care Current Topics And Controversies, Vol I (Trauma CME)
In up to 10% of patients who experience abdominal trauma, renal and urogenital systems will be involved. In polytrauma patients with other potentially life-threatening injuries, renal and genitourinary trauma may be overlooked initially, but a delayed or missed diagnosis of these injuries may result in preventable complications. This review provides a best-practice approach to the diagnosis and management of renal and genitourinary injuries, with an emphasis on the systematic approach needed to identify subtle injuries and avoid long-term urinary sequelae such as hypertension, incontinence, erectile dysfunction, chronic kidney disease, and nephrectomy.
Excerpt From This Issue

You’ve just arrived for a long Saturday overnight when the EMS notification pager goes off. Your first patient is a 23-year-old man who was in an altercation outside a bar. He is intoxicated, has bruises and red marks that look like shoe prints all over his abdomen, flanks, and chest, and tells you it hurts “everywhere.” On his right flank, he has a 1- by 2-centimeter wound that he thinks was made by a screwdriver. You put out a trauma page, and in the interim, you wonder: will a urinalysis really help in working up this patient? What kind of special imaging is he going to need? Should I order pre-op labs?”

Into the next trauma bay arrives a 46-year-old woman, also intoxicated, who was the unrestrained and ejected passenger in a high-speed, rollover motor vehicle crash. She is hypotensive and tachycardic. She has a pelvic binder on, with a tense, swollen belly extending above it. During the resuscitation, you notice she is bleeding briskly from her vagina. Your nursing colleague asks if you want a Foley catheter. Should you place one? Do you need to page urology as well as trauma? Is it necessary to alert interventional radiology of this patient’s arrival?


Product Reviews
Lewis M Moss, MD - 04/20/2018
Good article. I didn't know that greater than 30 RBC suggests gross hematuria and increased likelihood of major bladder trauma
Philip Chan, MD - 04/20/2018
Good review for trauma.
Kerith Joseph, MD - 04/18/2018
After reading this article, I will consider placing a Foley catheter in GU trauma and performing RUG myself
Mark S McIntosh, MD - 04/18/2018
Now I know I can perform RUG even if a catheter is in place
Nurani Kester - 04/18/2018
I have a better understanding of imaging techniques and pts who need delayed images
Vincent Gloria, PA-C - 03/14/2018
This was a very good review of injuries you need to consider in a trauma patient.
Stephen Neumann, MD - 02/01/2018
Better understanding of imaging options
Daniel Purcell, MD - 01/30/2018
I now have a better understanding of GU emergencies
James Bellone, MD - 11/15/2017
I am now better prepared to deal with GU trauma
Travis Inglis, DO - 11/11/2017
With this article, I will have better imaging studies
Donald Correll, DDS - 11/08/2017
This helped me have a better GU evaluation
Ravi Dodda, DO - 11/07/2017
I will now be more aware of potential life threatening GU injuries.
Charles R Nixon II, MD - 11/06/2017
Good article. I'll now have a lower threshold for doing CT customs and delayed contrast CTs
Thomas MacFarlane, MD - 07/21/2017
Nice article. Concise yet thorough. It will improve my management of trauma in patients with suspected urological injury, and I will have heightened suspicion for these injuries and more knowledge of diagnostic and management strategies.
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