Haematuria in Trauma

Assessment
Management

ASSESSMENT

DIAGNOSIS:

• Suspect renal trauma in any Blunt or Penetrating Abdominal Trauma
• Check for haematuria: There may be renal, bladder or urethral injury

NB: Renal and Abdominal Injuries frequently accompany multiple other injuries

ALWAYS look for co-existing injuries

In Blunt Trauma Renal injury is frequently associated with PELVIC FRACTURES

In Penetrating Trauma suspect if the wound site threatens the urinary tract

• Use a standard ATLS Approach:
• Assess – Intervene – Reassess: Assessment and Management occur in tandem.
• The goal is to determine whether there Is a clinically significant urogenital injury.
• DeMIST handover from ambulance
• TRIAGE patient using SATS 
• Measure and Record Vital Signs

Examination:

Primary: Assess ABCDE’S Then Secondary Head to Toe Examination

Specifically for suspected Renal Trauma:

• Check haemodynamic status and Hb.
• Look for potential sites of blood loss
• Screen for External Bleeding (NB: Look at the back)
• Screen for Internal Bleeding (Chest, abdomen, pelvis, long bones)
• Abdominal examination: Distension, Discolouration, Tenderness, Rebound, Peritonism
• Abdominal signs may be masked in head injury, intoxication, or other severe injuries
  • Look for associated pelvic fractures

PR examination:

• Look for Suspected Urethtal Injury: 
  • Perineal bruising
  • Blood at the external meautus of the urethra
  • PR Exam: Feel for high riding prostate and pelvic bone fragments
• Urine Catheter:
  • DO NOT PLACE if blood at the meatus or high riding prostate on PR

SAMPLE History:

• Signs and Symptoms: Abdominal Pain, Vomiting. Haematuria. Dysuria. Inability to void.
• Allergies. Medications.
• Past medical history: Previous Abdominal
• Last Meal.
• Events: Mechanism and Type of Injury.

INVESTIGATIONS:

• Hb.
• Urine Dipstix.
• FBC, U&E. Consider X Match
• XRays: Trauma series (C/Spine; CXR; Pelvis).
• Erect CXR for free air.
• Other XRays as clinically indicated
• EFAST US Scan.
• If stable, consider CT scan of abdomen.

MANAGEMENT