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28. A 53-year-old white man is brought to the emergency department by emergency medical services after he crashed his car into a tree. He was not wearing a seatbelt. Upon arrival in the emergency department the patient is clearly drunk but he is cooperative during the examination. Vital signs are: temperature 37.0°C (98.6°F), pulse 110/min, respirations 18/min and blood pressure 110/75 mm Hg. Physical examination shows generalized tenderness over the lower abdomen and pelvis. Neurologic examination is normal. X-ray films of the cervical spine, chest and pelvis are normal, as is CT scan of the head. On reexamination 3 hours later, no urinary output has been recorded. The patient is unable to produce a urine sample. He has received 1400 mL of lactated Ringer solution since the accident. Foley catheter is placed and yields 5 mL of bloody urine. X-ray film obtained after placement of the Foley catheter is shown. Which of the following is the most appropriate next step?

A) Foley catheter drainage for 10 days
B) Observation only
C) Percutaneous nephrostomy
D) Suprapubic catheter drainage
E) Surgical repair

D or E ? Thanks

I think its D. Urethral injury in this pt is most likely due to pelvic #. Managemet should be placement of suprapubic catheter followed by delayed urethral repair.

I think he has bladder rupture, need surgical repair. A Foley catheter is already placed,why do we still need Suprapubic catheter drainage ? Thank you.

EEE .......surgical repair !


rupture bladder .

e.

EEEE