Contents:

Protocol for paging Trauma team The Trauma Team Primary Survey Secondary Survey Radiology Placement Head injuries Spinal Injuries Chest Injury Blunt abdominal Trauma Penetrating abdominal Trauma Urological Injuries Eye Trauma

Hand Injuries Burns Carbon monoxide poisoning Obstetric Trauma Paediatric Trauma Paediatric resuscitation chart Hypothermia Universal Precautions Blood Alcohol Testing Patient transfers into Liverpool Patient transfers out of Liverpool Telephone numbers Acknowledgments

   Urological Trauma is easily overlooked, with the potential for serious long term disability.

RENAL TRAUMA

   Suspect in all cases with haematuria, or bruising in the region of the renal angles. Macroscopic haematuria is an indication for urgent IVP/CT with contrast, unless the bleeding is suspected to be coming from the lower urinary tract e.g. with pelvic injuries. Persistent microscopic haematuria should be investigated semi-urgently with IVP. All stable patients with macroscopic haematuria who are going to have a laparotomy should have an IVP prior to surgery; it is very difficult to assess the kidney lying in a large haematoma at operation, and most should be left undisturbed, there are a small number who have renal devascularisation, and the only hope for preservation is prompt diagnosis and treatment. Some patients with renal devascularisation will have minor or absent haematuria and the diagnosis is suspected on the basis of loin tenderness and the severity of injury to surrounding structures, such as the ribs, transverse processes, liver or spleen.

The indications for imaging the renal tract following blunt trauma are:

1. Macroscopic haematuria

2. Microscopic haematuria in a patient who has been shocked

3. Microscopic haematuria in patient under 16 years

URETERIC INJURIES

   Can occur in association with blunt or penetrating loin trauma They are rare.

BLADDER INJURIES

   Is frequently injured in association with pelvic fractures. 500 ml of urograffin run into the catheter with biplanar views will readily show such injuries. This investigation should be performed on all patients with pelvic fracture and macroscopic haematuria.

URETHRAL INJURIES

   Are suspected with blood at the urethral meatus and the history of an 'astride' injury, or pubic disruption. The bladder may be seen to sit high in the pelvis on X-Ray. If the diagnosis is suspected, urgent urethrography is required prior to the insertion of a urethral catheter.

(visit see our trauma xray collection for examples)

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