Medical history A 28-year-old male motorcyclist suffered a high-speed collision with a truck. His physical examination, in accordance with ATLS guidelines, is as follows: A: patent airway, cervical collar in place. B: Decreased breath sounds in the left hemithorax. C: HR: 135 bpm. SBP > 90 mmHg. Capillary refill time < 2â€. Weak peripheral arterial pulses. Tender abdomen painful to palpation with no peritoneal irritation signs. D: Glasgow Coma Scale: 15. Isocoric photorreactive pupils. E: Extensive left flank ecchymosis. FAST (Focused Assesment with Sonography for Trauma) demonstrated no free fluid. A computed tomography scan was ordered.Contrast-enhanced computed tomography (CT) scan, arterial phase, axial section at the level of the kidneys.Contrast-enhanced computed tomography (CT) scan, arterial phase, axial section at the level of the kidneys.Question: Based on the depicted images, clinical scenario and the ASST (American Association for the Surgery of Trauma) renal injury scale, the patient's kidney injury can be classified as: Grade IV kidney injury. Grade V kidney injury. Grade II kidney injury. Grade III kidney injury. Test Question (Sistema Único de Saúde – São Paulo) A 35-year-old car crash victim is brought to the Emergency Department. His physical examination is as follows: A: Orotracheal intubation. B: Breath sounds bilaterally present. SpO2 98%. C: HR: 110 bpm. BP: 100/70 mmHg. Capillary refill time: 2”. Stable pelvis, digital rectal exam with no abnormalities. D: Glasgow Coma Scale: 3. E: Multiple back injuries. Gross hematuria observed through urinary (Foley) catheter. Question:What is the best management option? Retrograde urethrocystography. Bladder irrigation. Diagnostic laparoscopy. FAST (Focused Assessment With Sonography for Trauma). Computed tomography scan of the abdomen. Time is Up! Time's up
