1. “I ruled out kidney damage with a normal urinalysis and sent her home. She came back with renal necrosis.”
While a urinalysis can help risk stratify and identify the severity of some types of renal trauma, a normal urinalysis is not sufficient to rule out the diagnosis. There are many case reports of patients with severe injuries and normal urinalyses, especially in vascular injury and penetrating trauma.
2. “He only had a little blood at the meatus on examination, so I went ahead and tried to place a Foley.”
In any patient for whom you have a concern for possible urethral injury, based on history, physical examination, presence of significant pelvic fractures on x-ray, or suspicious findings on initial CT scan, you should perform a RUG prior to attempting placement of a Foley catheter. Without this test, you risk turning a minor urethral injury into a major one.
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