Sections

Upper Genitourinary (Kidney, Ureter) Trauma

Sections Upper Genitourinary (Kidney, Ureter) Trauma
Overview
Presentation
- History
- Causes
- Show All
DDx
Workup
Treatment
Medication
Media Gallery
References

Medication

Medication Summary

Medications for patients with upper GU injuries relate to management of patients as critically injured rather than specifically to management of patients with GU injuries.

Class Summary

Antibiotics may be used for prophylaxis of infections of the injured GU tract. Empiric antimicrobial therapy must be comprehensive, covering all likely pathogens in the clinical setting.

Ampicillin and sulbactam (Unasyn)

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

Cefotetan (Cefotan)

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

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

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.

A review of opioid equivalents and conversions may be found in the following reference article:

http://emedicine.medscape.com/article/2138678-overview

Fentanyl (Sublimaze, Abstral, Actiq, Duragesic, Fentora, Ionsys, Lazanda, Onsolis, Subsys)

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

Fentanyl is highly lipophilic and protein bound. Prolonged exposure leads to accumulation in fat and delays weaning.

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

Parenteral form is DOC for conscious sedation analgesia and is ideal for analgesic action of short duration during anesthesia and the 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.

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

Easily and quickly reversed by naloxone.

Morphine sulfate (Astramorph, Duramorph, MS Contin, Avinza, Infumorph, Kadian, MorphaBond, Arymo ER)

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

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

Postoperatively, oral morphine sulfate extended-release formulations may be prescribed for severe pain, with immediate-release preparations used for breakthrough pain. Arymo ER is a morphine sulfate abuse-deterrent derivative.

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Media Gallery

Ruptured left kidney.
Avulsed left renal artery with thrombosis.
CT scan of abdomen and pelvis showing a urinoma.
Urinoma by CT.
Lateral view of a urinoma.
Contrast-filled urinoma.
Retrograde urethrogram showing a leak in the distal right ureter with an element of obstruction.

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Author

Sunny Mei-Chun Wang, MD, FACEP Assistant Residency Director, Bon Secour Mercy Health - Mercy Anderson; Emergency Physician, US Acute Care Solutions (USACS)

Sunny Mei-Chun Wang, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Kristine Song, MD ER Attending Physician, US Acute Care Solutions (USACS North); Emergency Medicine Residency Core Faculty, Simulations Director, Transitional Year Residency Program Director, Mercy Health — Anderson Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Legome, MD Professor and Chair, Department of Emergency Medicine, Mount Sinai St Lukes and Mount Sinai West; Vice Chair of Academic Affairs, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai

Eric L Legome, MD is a member of the following medical societies: American College of Emergency Physicians, Eastern Association for the Surgery of Trauma, New York American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

David S Howes, MD Professor of Medicine and Pediatrics, Residency Program Director Emeritus, Section of Emergency Medicine, University of Chicago, University of Chicago, 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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Imad S Dandan, MD Trauma Medical Director, 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, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Walid A Farhat, MD, FRCS(C), FACS, GPLLM Professor and Chief of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health

Walid A Farhat, MD, FRCS(C), FACS, GPLLM is a member of the following medical societies: American Academy of Pediatrics, American Association of Pediatric Urologists, American College of Surgeons, American Urological Association, Canadian Urological Association, Societies for Pediatric Urology, Society for Fetal Urology

Disclosure: Nothing to disclose.

Sections Upper Genitourinary (Kidney, Ureter) Trauma
Overview
Presentation
- History
- Causes
- Show All
DDx
Workup
Treatment
Medication
Media Gallery
References

Upper Genitourinary (Kidney, Ureter) Trauma Medication

Medication Summary

Antibiotics

Class Summary

Ampicillin and sulbactam (Unasyn)

Ampicillin and sulbactam (Unasyn)

Cefotetan (Cefotan)

Cefotetan (Cefotan)

Analgesics

Class Summary

Fentanyl (Sublimaze, Abstral, Actiq, Duragesic, Fentora, Ionsys, Lazanda, Onsolis, Subsys)

Fentanyl (Sublimaze, Abstral, Actiq, Duragesic, Fentora, Ionsys, Lazanda, Onsolis, Subsys)

Morphine sulfate (Astramorph, Duramorph, MS Contin, Avinza, Infumorph, Kadian, MorphaBond, Arymo ER)

Morphine sulfate (Astramorph, Duramorph, MS Contin, Avinza, Infumorph, Kadian, MorphaBond, Arymo ER)

References

Tables

Contributor Information and Disclosures

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