精華區beta medstudent 關於我們 聯絡資訊
※ 引述《pinknatty (小龍)》之銘言: : 一位37歲男性工人從工地掉下來,理學檢查時病人意識清楚,但發現尿道口有血跡,而且 : 陰囊有血腫,會陰有瘀傷,接下來你最先要安排何種檢查? : A. Intravenous pyelogram : B. cystography : C. retrograde urethrogram : D. contrast-enhanced CT : 考選部答案: C : 建議答案: C.D皆對 我補充Schwartz's principles of surgery 8ed 的資料 跟你申覆結果一樣 申覆理由: Pelvis Blunt injury to the pelvis frequently produces complex fractures. Plain x-rays will reveal gross abnormalities, but CT scans may be necessary to assess the pelvic for stability. Surgeons should be aware that life-threatening hemorrhage can be associated with pelvic fractures. 因此病人跌倒, 除了泌尿道有可能受傷外, 也應注意pelvic fractures. 本題沒有 x-ray, 無法得知pelvic bone的狀況, 況且依題意病人算stable, 除了做retrograde urethrogram外, 也應做contrast-enhanced CT來評估病人的pelvic fracture. 故建議答 案為C或D ps: 要不要我用Schwartz's的資料寄出去, 你用Sabinston的資料寄出去好了 XD 參考資料: Schwartz's principles of surgery 8ed : 以下資料摘錄自Sabinston textbook of surgery : chapter 20 -management of acute trauma- abdominal trauma-pelvic fracture : <<Injuries to the Urethra>> : Disruption of the urethra is a rare injury in women. It is found mostly in : men, """frequently after either pelvic fractures or straddle injuries""". : <<Pelvic Fractures>> : Unstable pelvic fractures are accompanied, most of the time, by """major : retroperitoneal hemorrhage"""…. CT scan of the pelvis provides information on : displacement of the sacroiliac joint, acetabular fractures, and sacral : fractures; however it should not be performed in a hemodynamically unstable : patient. : Because of the high incidence of associated intra-abdominal injuries, : supraumbilical DPL should be performed; however there is an approximately 35% : rate of false-positive results with DPL in the presence of retroperitoneal : hematoma. """Stable patients are best evaluated with an abdominal CT scan.""" : 依上述,病人的意識狀態清楚,應屬於hemodynamically stable,且懷疑pelvic fracture : 應該要做abdominal CT吧?! -- ※ 發信站: 批踢踢實業坊(ptt.cc) ◆ From: 118.169.70.25 ※ 編輯: surgeoner 來自: 118.169.70.25 (02/23 10:11)