EVALUATION of ASSOCIATED INJURIES

1. Genitourinary - genital, urethral and bladder injuries can occur with severe pelvic injuries. A thorough examination of the genitals and perineum must be performed.

a. Urethra - A urethral injury should be suspected with blood at the urethral meatus or a high-riding prostate on the initial rectal exam. A urinary catheter should be gently inserted and if there is any difficulty with initial catheter placement, urethral integrity must be evaluated via retrograde urethrography.

b. Bladder - If gross hematuria is noted, a cystogram should be performed to rule out bladder injury. (See the JTS Genitourinary Injury Trauma Management CPG.)

c. Testicular and vaginal injuries – examine for injuries, refer to the JTS Genitourinary Injury Trauma Management CPG for more detailed information.

2. Rectal - a digital rectal examination should be performed. If defects or blood are noted, a more thorough exam is warranted with either rigid or flexible proctoscopy to evaluate for rectal injuries. (See the JTS High Bilateral Amputations and Dismounted Complex Blast Injury CPG for more details.)

3. Perineal wounds - thorough examination should be performed; perineal wounds can easily be missed and are often associated with the injuries above. See the JTS High Bilateral Amputations And Dismounted Complex Blast Injury CPG for more details.