Lower Genitourinary Trauma Medication

  • Author: Imad S Dandan, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jun 7, 2011
 

Medication Summary

Medications for patients with lower GU tract injuries relate to the management of patients as critically injured rather than management specific to the GU injury.

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Antibiotics

Class Summary

Used for prophylaxis against infections of the GU tract. Empiric antimicrobial therapy must be comprehensive, covering all likely pathogens in the clinical setting.

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Ampicillin and sulbactam (Unasyn)

 

Drug combination of beta-lactamase inhibitor with ampicillin. Covers skin, enteric flora, and anaerobes. Not ideal for nosocomial pathogens.

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Cefotetan (Cefotan)

 

Second-generation cephalosporin indicated for infections caused by susceptible gram-positive cocci and gram-negative rods.

Dosage and route of administration depends on condition of patient, severity of infection, and susceptibility of causative organism.

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Analgesics

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained trauma.

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Fentanyl (Sublimaze)

 

A synthetic opioid that is 75-200 times more potent and much shorter half-life than morphine sulfate. Has less hypotensive effects and is safer in patients with hyperactive airway disease than morphine because of minimal-to-no associated histamine release. By itself, it causes little cardiovascular compromise, although addition of benzodiazepines or other sedatives may result in decreased cardiac output and blood pressure.

Highly lipophilic and protein-bound. Prolonged exposure leads to accumulation in fat and delays weaning process.

Consider continuous infusion because of the short half-life of fentanyl.

Parenteral form is DOC for conscious sedation analgesia. Ideal for analgesic action of short duration during anesthesia and immediate postoperative period.

Excellent choice for pain management and sedation with short duration (30-60 min) and easy to titrate. Easily and quickly reversed by naloxone.

After initial parenteral dose, subsequent parenteral doses should not be titrated more frequently than q3h or q6h thereafter.

Transdermal form is used only for chronic pain conditions in opioid tolerant patients. When using transdermal dosage form, majority of patients are controlled with 72 h dosing intervals; however, some patients require dosing intervals of 48 h.

Easily and quickly reversed by naloxone.

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Morphine sulfate (Astramorph, Duramorph)

 

DOC for analgesia due to reliable and predictable effects, safety profile, and ease of reversibility with naloxone.

Various IV doses are used; commonly titrated until desired effect obtained.

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Contributor Information and Disclosures
Author

Imad S Dandan, MD  Consulting Surgeon, Department of Surgery, Trauma Section, Scripps Memorial Hospital

Imad S Dandan, MD is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, American Medical Association, American Trauma Society, California Medical Association, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Walid A Farhat, MD, FRCS(C)  Associate Professor, Department of Surgery, University of Toronto; Staff Physician, Division of Urology, The Hospital for Sick Children

Walid A Farhat, MD, FRCS(C) is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, College of Physicians and Surgeons of Ontario, and International Pediatric Endosurgery Group

Disclosure: Nothing to disclose.

Specialty Editor Board

David S Howes, MD  Professor of Medicine and Pediatrics, Section Chief and Emergency Medicine Residency Program Director, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

David S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physicians-American Society of Internal Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Walsh PC. Genitourinary trauma. In: Campbell's Urology. 6th ed. WB Saunders Co; 1992:2574.

  2. Guerriero WG. Trauma to the kidneys, ureters, bladder, and urethra. Surg Clin North Am. Dec 1982;62(6):1047-74. [Medline].

  3. American College of Surgeons Committee on Trauma. Initial assessment and management. Advanced Trauma Life Support Program for Physicians;1993:9-46.

  4. Cutinha P, Chapelle CR. Bladder injuries. Surg Int. 1997;37:107-12.

  5. Png D, Chapelle CR. Urethral injuries. Surg Int. 1997;37:97-101.

  6. James MJ. Investigation of the lower urinary tract. Surgery. 1995;13(2):37.

  7. Peterson NE. Traumatic posterior urethral avulsion. Monogr Urol. 1986;7:61.

  8. Patel A, Harrison SCW. Scrotal trauma. Surg Int. 1997;37:118-20.

  9. Ziran BH, Chamberlin E, Shuler FD, Shah M. Delays and difficulties in the diagnosis of lower urologic injuries in the context of pelvic fractures. J Trauma. Mar 2005;58(3):533-7. [Medline].

  10. Styles RA. Hematuria. Surgery. 1996;14:213.

  11. Trunkey D. Initial treatment of patients with extensive trauma. N Engl J Med. May 2 1991;324(18):1259-63. [Medline].

  12. Peterson NE. Current management of urethral injuries. Urol Annual. 1988;143-79.

  13. Ishak C, Kanth N. Bladder trauma: multidetector computed tomography cystography. Emerg Radiol. Apr 27 2011;[Medline].

  14. Krieger JN, Algood CB, Mason JT, et al. Urological trauma in the Pacific Northwest: etiology, distribution, management and outcome. J Urol. Jul 1984;132(1):70-3. [Medline].

  15. Richardson JR Jr, Leadbetter GW Jr. Non-operative treatment of the ruptured bladder. J Urol. Aug 1975;114(2):213-6. [Medline].

  16. Wu TS, Pearson TC, Meiners S, Daugharthy J. Bedside Ultrasound Diagnosis of a Traumatic Bladder Rupture. J Emerg Med. Mar 24 2011;[Medline].

 
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Normal urethrogram.
Retrograde urethrogram showing an irregularity of the urethra indicating injury secondary to a shotgun wound.
Normal bladder on CT scan.
Ruptured dome of urinary bladder detected by retrograde cystogram.
Ruptured urinary bladder detected by CT scan.
Extravasated contrast in abdominal cavity secondary to ruptured bladder.
 
 
 
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