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Bladder Injury, Emergency Medicine

Mary E. Johnson Reviewed 06/2017
 


Basics

Description

  • Blunt trauma is the most common mechanism.

  • 10% of pelvic fractures have serious bladder injury.

  • 80–90% of bladder ruptures have pelvic fracture.

  • Mortality: 17–22% overall; 60% if combin...

Diagnosis

Signs and Symptoms

Triad: 
  • Gross hematuria

  • Suprapubic pain

  • Difficulty voiding

History

Establish potential mechanism. 

Physical Exam

Evaluate urethral meatus—if blood is present, do not insert Foley ...

Treatment

Pre-Hospital

Do not attempt bladder catheterization in the field. 

Initial Stabilization/Therapy

  • ABCs

  • Early urologic consultation

Ed Treatment/Procedures

  • Urologic consultation is needed when bladd...

Follow-Up

Disposition

Admission Criteria

  • Concurrent major trauma requiring admission or observation

  • Surgical intervention required

Discharge Criteria

  • Bladder contusion with no rupture or other major trauma...

Pearls and Pitfalls

  • Any free fluid on CT or US exam should raise suspicion for bladder injury.

  • Unresponsive, altered, and intoxicated patients warrant careful exam.

  • Penetrating injuries to lower abdomen...

Additional Reading

  • Marx  JA, Hockberger  RS, Walls  RM, et al., eds. Rosen's Emergency Medicine Concepts and Clinical Practice. 8th ed. St. Louis, MO: Mosby; 2013.

  • Ramchadani  P, Buckler  PM. Imaging...

Codes

ICD9

  • 665.50 Other injury to pelvic organs, unspecified as to episode of care or not applicable

  • 867.0 Injury to bladder and urethra, without mention of open wound into cavity

  • 867.1 Injury to bladder...

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