Trauma Guideline Manual - SUNY Upstate Medical University

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120____________ Trauma Guidelines ManualSUNY Upstate Trauma Center7. Procedures:a. Cystogram (per Radiology):i. Place Foley catheter.ii. Obtain hypaque or renografin (full-strength).iii.iv.Open a Toomey syringe and remove plunger. Attach barrel to the Foley catheter.Place 300 ml of contrast (10 ml/kg in children) into bladder by gravity flow throughthe Foley catheter.v. Obtain pelvis film.vi. Drain bladder.vii. Obtain post-void films of pelvis.b. One-shot IVP:i. Clamp Foley catheter if one has been placed (to obtain “free cystogram”).ii. Administer intravenous injection of contrast (1 ml/kg).iii. Obtain abdominal film at 5 minutes after completion of contrast Infusion.
Trauma Guideline Manual______________SUNY Upstate Trauma Center121PRACTICE GUIDELINES: MANAGEMENT OF KIDNEY AND BLADDER INJURIESOBJECTIVE:Provide guidelines for the management of renal contusions, renal fractures, renal-vascularinjuries and bladder perforations.DEFINITIONS:Renal contusions: Defect(s) in perfusion of the kidney on CT or IVP that is consistent with aparenchymal contusion.Renal fracture: A parenchymal defect of the kidney associated with hematoma or urinomaaround the kidney.Reno-vascular injuries: Occlusion(s) of the renal artery as evidenced by lack of perfusion to akidney on CT, IVP or angiogram.Bladder perforation: Extravasation of contrast from the bladder on CT, IVP or cystogram.Extraperitoneal perforations are contained in the retroperitoneal space around the bladder.Intraperitoneal perforation is associated with contrast in the peritoneal cavity that outlines bowel.GUIDELINES:1. Evaluation:a. Consider renal injury with any injury associated with hematuria (see Guideline forhematuria).b. Consider renal injury with penetrating abdominal injury (see Guideline for evaluation ofpenetrating abdominal trauma).c. Consider bladder injury when there is significant hematuria with a pelvic fracture orlower abdominal pain (see Guideline for cystogram).2. Penetrating Injuries:a. All gunshot wounds to the kidney require exploration for the possibility of associatedinjuries. Obtain one-shot IVP (or, in the stable patient, a CT scan) prior to surgery orintra-operatively to determine presence of contralateral kidney.b. All stab wounds to the kidney require specific evaluation:i. If kidney is injured from anterior stab wound, exploration is required because of thepossibility of associated intra-abdominal injuries.ii. If kidney is injured from a flank wound, CT must show that the wound is limited tothe kidney with minimal blood in the perirenal space. If urine is present around thekidney, consider exploration for disrupted collecting system or ureter.3. Blunt Injuries:a. Renal contusion:i. Diagnosed as a perfusion defect on CT or IVP.ii. No definitive treatment necessary.iii. Follow-up urinalysis every day until RBC
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Trauma Guideline Manual - SUNY Upstate Medical University

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