had a through and through gunshot tonight that went through left leg and then through the member
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 cath him.
I tried and couldn't get it so told the trauma surgeon who said to call urology to come
my ER doctor went ballistic when he found out I had tried to cath the pt, said never listen to the trauma doc's and always ask the ER doc if it is okay first.
Fortunately in the long run the guys member is okay, I didn't damage the urethra after all.
I feel terrible. I know that you never cath a pelvic fracture etc, but I stupidly thought that it was okay if the trauma surgeon said to.
I am not a nurse who listens and obeys the doctors no matter what but I didn't second quess this order like I should have.
Thank God my pt is okay in spite of me.
I did report myself to the house super and the urologist. They were okay with what I did, but of course that doesn't make it right.
It is so scarey to think how easy it is to make a mistake, no matter how careful a nurse you are.
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.
It was about 3 hours or a little more that we did not know how much damage there was to the member. 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.
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.
Oz2
101 Posts
Peni?