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
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?!
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※ 編輯: pinknatty 來自: 111.249.52.214 (02/23 00:46)