Case 330

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 < 2”. 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.

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:

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.
What is the best management option?

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