Who is in charge of my pt - page 3

Long story-short had a through and through gunshot tonight that went through left leg and then through the penis ER doctor said not to cath the pt, and then a little later the trauma surgeon who came in to see my pt said to... Read More

  1. 0
    Quote from gonzo1
    In this case there was the worry that the bullet had transected the urethra and that the foley would further ruin it.
    Why wasn't this determined quickly through CT and/or US?

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  2. 0
    Oh, I can see being hesitant about cathing someone with a bullet hole in the penis. That makes sense to me.

    But the pelvic fracture thing was what I was a little confused about-but I don't work ER so I wondered if that's what it was about...
  3. 0
    When the urologist came in we ran omnipaque dye through the penis and saw that the urethra and bladder was intact by taking an xray.
    This was very cool and if I ever get another case like this will suggest to the ER doc that we do it
  4. 0
    Had a similar situation, a guy came in bit by a rattle snake (and his drunk buddies brought the snake in to the ER too, but that's another story). we had a locums in the ER, and the hospitalist came in too. they were fighting over solumedrol or anti-venin (yes that is the way it is spelled not anti-venom). The guy was in full anaphylaxis and me and the other nurse just told our US to call the CRNA to intubate and then call for a helicopter.

    The docs were so busy trying to talk each other down (read yelling at each other) that they didn't even realize until the CRNA was there and we were trying to get him intubated.

    They were kind of mad at us, but still fighting. The medical director did an investigation and told us both that we did an outstanding job and probably saved the guys life.
  5. 0
    some bleeding penis (what's the plural)
  6. 0
    Quote from Oz2


  7. 0
    I guess the point on which I'm stuck is ... for what period of time was it "unknown" whether or not the urethra was transected?

    With an obvious soft tissue injury to the groin, I can understand not inserting the foley immediately on the patient's arrival in the ER ... but foley insertion is generally not a task completed in the first 10 minutes of a trauma anyway. After CT/x-ray/other imaging ... then the extent of injuries is known and other treatment proceeds.
  8. 0
    It was about 3 hours or a little more that we did not know how much damage there was to the penis. Pt came in about 930 or 10pm and we didn't know until the urologist came at about 0130 and completely checked the guy out.
    By the way the kid has gone home and is rumored to be doing fine.
  9. 0
    Quote from gonzo1
    It was about 3 hours or a little more that we did not know how much damage there was to the penis.
    This is sometimes the problem with trauma at non-trauma centers.

    Quote from gonzo1
    By the way the kid has gone home and is rumored to be doing fine.
    Good to hear!
  10. 0
    Quote from Altra
    But this don't-catheterize-a-pelvic-fx is just not typical practice. Do you propose repeatedly positioning & repositioning that fractured pelvis on a bedpan?? I didn't think so.
    I suppose I didn't clarify our "don't cath a pelvic fx" practice. I didn't mean that we don't cath any pelvic fx patient. If there is a pelvic fracture we watch for evidence of a urethral/bladder injury. Especially if it is an unstable pelvis. Once cleared by CT, by all means cath.

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