trauma

EM@3AM: Bladder Rupture

A 30-year-old male presents to the ED via EMS with severe hip and groin pain after an accident. He denies loss of consciousness, is not on any blood thinners, and currently complains of pain in his hips/groin. Initial assessment on arrival includes vital signs BP 134/86, HR 94, RR 16, SpO2 98% on room air, and temperature 99.0F. He is speaking and mentating appropriately but in significant discomfort when you exam his pelvis. Blood is seen at the urethral meatus, and the pelvis is unstable. There is no obvious perineal ecchymosis at this time. The rest of the exam is unremarkable. What type of injury should be considered with blood at the urethral meatus and suspected pelvic fracture?

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EM@3AM: Testicular Rupture

A 25-year-old male is brought to the ED by EMS with pain in the right scrotum after a motorcycle crash. The patient was wearing a helmet, could ambulate at the scene, and states his main concern is his right scrotal pain. Review of systems is unremarkable. He has ecchymosis of right scrotum with exquisite tenderness and perineal bruising. What’s the next step in your evaluation and treatment?

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