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Page 1: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

Genitourinary EmergenciesGenitourinary Emergencies

Page 2: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

ASSESSMENTASSESSMENT

Primary SurveyPrimary Survey Secondary SurveySecondary Survey

Page 3: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

RISK FACTORSRISK FACTORS

PERSONAL HABITSPERSONAL HABITS DECREASED FLUID INTAKEDECREASED FLUID INTAKE IMMOBILITYIMMOBILITY DIET HIGH IN OXALATESDIET HIGH IN OXALATES POOR PERINEAL HYGIENEPOOR PERINEAL HYGIENE PREGNANCYPREGNANCY DIABETESDIABETES

Page 4: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

RISK FACTORSRISK FACTORS

SPINAL CORD INJURYSPINAL CORD INJURY FOLEY CATHETER INSERTIONFOLEY CATHETER INSERTION PREVIOUS INFECTIONSPREVIOUS INFECTIONS TRAUMATRAUMA EXTREMES OF AGEEXTREMES OF AGE

Page 5: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

FOCUSED SURVEYFOCUSED SURVEYSUBJECTIVE DATASUBJECTIVE DATA

HISTORY OF PRESENT HISTORY OF PRESENT ILLNESSILLNESS

MEDICAL HISTORYMEDICAL HISTORY

Page 6: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

OBJECTIVE DATAOBJECTIVE DATA

PHYSICAL EXAMPHYSICAL EXAM A. GENERAL SURVEYA. GENERAL SURVEY B. INSPECTIONB. INSPECTION C. PERCUSSIONC. PERCUSSION D. PALPATIOND. PALPATION

Page 7: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

DIAGNOSTIC PROCEDURESDIAGNOSTIC PROCEDURES

LAB STUDIESLAB STUDIES RADIOGRAPHIC STUDIESRADIOGRAPHIC STUDIES

Page 8: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

AGE RELATED AGE RELATED CONSIDERATIONSCONSIDERATIONS

PEDIATRICPEDIATRIC

A. GROWTH AND DEVELOPMENT A. GROWTH AND DEVELOPMENT

B. PEARLSB. PEARLS

GERIATRICGERIATRIC

A. AGE RELATEDA. AGE RELATED

B. PEARLSB. PEARLS

Page 9: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

ACUTE RENAL FAILUREACUTE RENAL FAILURE

THREE TYPES OF RENAL FAILURETHREE TYPES OF RENAL FAILURE

A. PRERENALA. PRERENAL

B. INRARENAL (intrinsic)B. INRARENAL (intrinsic)

C. POSTRENALC. POSTRENAL

Page 10: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

PRERENALPRERENAL

SHOCKSHOCK CHFCHF SEPSISSEPSIS ANAPHYLAXISANAPHYLAXIS PERICARDIAL TAMPONADEPERICARDIAL TAMPONADE PULMONARY EMBOLISMPULMONARY EMBOLISM

Page 11: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

INTRARENALINTRARENAL

ACUTE INERSTITAL NEPHRITISACUTE INERSTITAL NEPHRITIS EXPOSURE TO NEPHROTOXINSEXPOSURE TO NEPHROTOXINS ACUTE GLOMERULONEPHRITISACUTE GLOMERULONEPHRITIS VASCULITISVASCULITIS RENAL ARTERY OR VEIN STENOSISRENAL ARTERY OR VEIN STENOSIS

Page 12: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

POSTRENALPOSTRENAL

URETHRAL OR BLADDER CANCERURETHRAL OR BLADDER CANCER RENAL CALCULIRENAL CALCULI PROSTATIC HYPERPLASIA OR CAPROSTATIC HYPERPLASIA OR CA CERVICAL CANCERCERVICAL CANCER URETHRAL STRICTUREURETHRAL STRICTURE

Page 13: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

URINARY TRACT INFECTIONURINARY TRACT INFECTION

Page 14: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS

FEVERFEVER HEMATURIAHEMATURIA CHILLS AND FEVERCHILLS AND FEVER DYSURIA AND/OR URGENCYDYSURIA AND/OR URGENCY DULL FLANK PAINDULL FLANK PAIN NAUSEANAUSEA LEUKOCYTOSISLEUKOCYTOSIS

Page 15: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

PLANNING AND INTERVENTIONPLANNING AND INTERVENTION

ANTIBIOTICSANTIBIOTICS ANALGESICSANALGESICS ANTYPYRETICSANTYPYRETICS

Page 16: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

DISCHARGE INSTRUCTIONSDISCHARGE INSTRUCTIONS

FINISH ALL ANTIBIOTICSFINISH ALL ANTIBIOTICS CLEAN FROM FRONT TO BACKCLEAN FROM FRONT TO BACK VOID FREQUENTLYVOID FREQUENTLY AVOID BUBBLE BATHSAVOID BUBBLE BATHS VOID AFTER INTERCOURSEVOID AFTER INTERCOURSE CLEAN FORESKIN IN MALESCLEAN FORESKIN IN MALES INCREASE FLUID INTAKEINCREASE FLUID INTAKE

Page 17: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

PYELONEPHRITISPYELONEPHRITIS

Page 18: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

PREDESPOSING FACTORSPREDESPOSING FACTORS

PREGNANCYPREGNANCY DELAY IN TREATMENT OF UTIDELAY IN TREATMENT OF UTI IMMUNOSUPRESSIONIMMUNOSUPRESSION MORE THAN 3 UTI IN ONE YEARMORE THAN 3 UTI IN ONE YEAR

Page 19: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS

DULL UNILATERAL FLANK PAINDULL UNILATERAL FLANK PAIN FEVER AND CHILLSFEVER AND CHILLS RECENT UTI OR STDRECENT UTI OR STD DYSURIADYSURIA FREQUENCYFREQUENCY HEMATURIAHEMATURIA

Page 20: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

PLANNING AND INTERVENTIONPLANNING AND INTERVENTION

FLUIDSFLUIDS ANALGESICSANALGESICS IV ANTIBIOTICSIV ANTIBIOTICS ANTIPYRETICSANTIPYRETICS

Page 21: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

URINARY CALCULIURINARY CALCULI

Page 22: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

RISK FACTORSRISK FACTORS

HYPERCALCEMIAHYPERCALCEMIA UTIUTI GOUTGOUT DIETDIET DEHYDRATIONDEHYDRATION PREGNANCYPREGNANCY

Page 23: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS

ASYMPTOMATIC UNTIL STONE MOVESASYMPTOMATIC UNTIL STONE MOVES BACKACHEBACKACHE DYSURIADYSURIA RENAL COLICRENAL COLIC HEMATURIAHEMATURIA NAUSEANAUSEA SWEATINGSWEATING

Page 24: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

PLANNING AND INTERVENTIOSPLANNING AND INTERVENTIOS

IV FLUIDSIV FLUIDS PAIN MEDICATIONPAIN MEDICATION X RAYS OR CTX RAYS OR CT STRAIN URINESTRAIN URINE LITHOTRIPSYLITHOTRIPSY SURGERYSURGERY

Page 25: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

CRITERIA FOR ADMISSONSCRITERIA FOR ADMISSONS

PAIN MANAGEMENTPAIN MANAGEMENT SOLITARY KINDEYSOLITARY KINDEY ILEUSILEUS BLADDER STONESBLADDER STONES INFECTIONINFECTION

Page 26: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

DISCHARGEDISCHARGE

PAIN MEDSPAIN MEDS INCREASE FLUIDSINCREASE FLUIDS STRAIN URINESTRAIN URINE RETURN FOR INCREASE PAIN OF RETURN FOR INCREASE PAIN OF

VOMITINGVOMITING

Page 27: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

TESTICULAR TORSIONTESTICULAR TORSION

Page 28: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS

UNILATERAL TESTICULAR PAINUNILATERAL TESTICULAR PAIN SCROTAL SWELLINGSCROTAL SWELLING REDNESS AND TENDERNESSREDNESS AND TENDERNESS

Page 29: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

DIAGNOSTICDIAGNOSTIC

UAUA CBCCBC DOPPLER ULTRASOUND FLOW STUDYDOPPLER ULTRASOUND FLOW STUDY

Page 30: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

EPIDIDYMIDITISEPIDIDYMIDITIS

Page 31: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS

GRADUAL ONSET OF SCROTAL PAINGRADUAL ONSET OF SCROTAL PAIN RED, SWOLLEN, WARM SCROTUMRED, SWOLLEN, WARM SCROTUM DYSURIA OR URETHRAL DISCHARGEDYSURIA OR URETHRAL DISCHARGE TENDERNESS IN GROIN OR LOW ABDTENDERNESS IN GROIN OR LOW ABD DUCK WADDLE GAITDUCK WADDLE GAIT

Page 32: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

DIAGNOSTICDIAGNOSTIC

UA WITH C&SUA WITH C&S GRAM STAIN IF ANY DISCHARGEGRAM STAIN IF ANY DISCHARGE ULTRASOUNDULTRASOUND

Page 33: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

PLANNING AND INTERVENTIONPLANNING AND INTERVENTION

ANTIBIOTICSANTIBIOTICS ANALGESICSANALGESICS SCROTAL SUPPORT WITH ELEVATIONSCROTAL SUPPORT WITH ELEVATION AVOID PHYSICAL STRAINAVOID PHYSICAL STRAIN

Page 34: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

URETHRAL INJURYURETHRAL INJURY

Page 35: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

FEMALESFEMALES

RARERARE CHILDBIRTH OR VAGINAL SURGERYCHILDBIRTH OR VAGINAL SURGERY STRADDLE INJURIESSTRADDLE INJURIES PELVIC FRACTUREPELVIC FRACTURE

Page 36: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

MALESMALES

TRAUMATRAUMA MUTILATIONMUTILATION SEXUAL ACTIVITYSEXUAL ACTIVITY INSTRUMENTATIONINSTRUMENTATION

Page 37: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS

PAINPAIN HEMATURIAHEMATURIA BLOOD AT URINARY MEATUSBLOOD AT URINARY MEATUS HEMATOMA OF ABD.OR PERNIEUMHEMATOMA OF ABD.OR PERNIEUM

Page 38: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

DIAGNOSTICDIAGNOSTIC

LABSLABS X RAYSX RAYS

Page 39: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

TREATMENTTREATMENT

CATHETERIZATIONCATHETERIZATION SURGERYSURGERY

Page 40: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

BLADDER RUPTUREBLADDER RUPTURE

Page 41: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

SIGNS AND SYPTOMSSIGNS AND SYPTOMS

PAINPAIN INABILITY TO VOIDINABILITY TO VOID POSSIBLE HEMATURIAPOSSIBLE HEMATURIA BLOOD AT MEATUSBLOOD AT MEATUS ABD. TENDERNESSABD. TENDERNESS LOW ABD. OR PERINEAL HEMATOMALOW ABD. OR PERINEAL HEMATOMA

Page 42: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

DIAGNOSTICDIAGNOSTIC

LABS -- CBC, PT, PTT, UALABS -- CBC, PT, PTT, UA

X-RAYS – 3 VIEW ABD.X-RAYS – 3 VIEW ABD.

PELVIS PELVIS

PELVIC ULTRASOUNDPELVIC ULTRASOUND

Page 43: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

PLANNING AND INTERVENTIONPLANNING AND INTERVENTION

HEMODYNAMIC STABLE (ESPECIALLY HEMODYNAMIC STABLE (ESPECIALLY WITH PELVIC FRACTUREWITH PELVIC FRACTURE

SURGERYSURGERY SUPRAPUBIC TAPSUPRAPUBIC TAP PAIN MEDSPAIN MEDS ANTIBIOTICSANTIBIOTICS SURGERYSURGERY

Page 44: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

RENAL TRAUMARENAL TRAUMA

Page 45: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS

PAINPAIN NAUSEA AND VOMITINGNAUSEA AND VOMITING RETROPERITONEAL HEMATOMARETROPERITONEAL HEMATOMA HEMATURIAHEMATURIA OLIGURIAOLIGURIA CONTUSIONSCONTUSIONS ABSENT OR DECREASED BOWEL ABSENT OR DECREASED BOWEL

SOUNDSSOUNDS

Page 46: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

DIAGNOSTIC PROCEDURESDIAGNOSTIC PROCEDURES

LABSLABS CBC, SERIAL HEMATOCRITS, CBC, SERIAL HEMATOCRITS,

LYTES, BUN, CREATININE, PT, PTT, UA, LYTES, BUN, CREATININE, PT, PTT, UA,

TYPE AND CROSSTYPE AND CROSS

X-RAYS ABD FILMS, CT OF ABDX-RAYS ABD FILMS, CT OF ABD

Page 47: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

PLANNING AND INTERVENTIONPLANNING AND INTERVENTION

MONITOR HEMODYNAMIC STATUSMONITOR HEMODYNAMIC STATUS BLOOD TRANSFUSIONSBLOOD TRANSFUSIONS PAIN MEDSPAIN MEDS ANTIBIOTICSANTIBIOTICS SURGERYSURGERY

Page 48: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

PRIAPISMPRIAPISM

Page 49: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

MEDICAL HISTORYMEDICAL HISTORY

SICKLE CELL CRISISSICKLE CELL CRISIS MEDICATIONMEDICATION SPINAL CORD INJURYSPINAL CORD INJURY

Page 50: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS

PENILE ERECTIONPENILE ERECTION BLADDER DISTENTIONBLADDER DISTENTION PARALYSIS WITH SPINAL CORD INJURYPARALYSIS WITH SPINAL CORD INJURY PAINPAIN ANXIETYANXIETY

Page 51: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

DIAGNOSTIC PROCEDURESDIAGNOSTIC PROCEDURES

LABSLABS

Page 52: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

PLANNING AND INTERVENTIONPLANNING AND INTERVENTION

PAIN MANAGEMENTPAIN MANAGEMENT CATHETERIZATIONCATHETERIZATION UROLOGICAL CONSULTUROLOGICAL CONSULT SURGICAL INTERVENTIONSURGICAL INTERVENTION NEEDLE ASPIRATIONNEEDLE ASPIRATION

Page 53: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

FOREIGN BODIESFOREIGN BODIES

Page 54: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS

PAINPAIN MEDICAL HISTORYMEDICAL HISTORY CHANGE IN URINARY PATTERNCHANGE IN URINARY PATTERN HEMATURIAHEMATURIA URETHRAL DISCHARGEURETHRAL DISCHARGE FB VISIBLE AT MEATUSFB VISIBLE AT MEATUS

Page 55: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

DIAGNOSTIC PROCEDUREDIAGNOSTIC PROCEDURE

UAUA URETHRAL CULTUREURETHRAL CULTURE KUBKUB

Page 56: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

PLANNING AND INTERVENTIONPLANNING AND INTERVENTION

TREAT BLADDER DISTENTIONTREAT BLADDER DISTENTION ESTABLISH URINE OUTPUTESTABLISH URINE OUTPUT TREAT PAINTREAT PAIN PREPARE FOR MEDICAL PREPARE FOR MEDICAL

INTERVENTIONINTERVENTION MEDS. PAIN, ANTIBIOTICS, MEDS. PAIN, ANTIBIOTICS,

CONSCIOUS SEDATIONCONSCIOUS SEDATION PSYCH CONSULTPSYCH CONSULT

Page 57: Genitourinary Emergencies. ASSESSMENT Primary Survey Primary Survey Secondary Survey Secondary Survey

DISCHARGE INSTRUCTIONSDISCHARGE INSTRUCTIONS

MEDICATIONSMEDICATIONS MONITOR URINE OUTPUTMONITOR URINE OUTPUT HYDRATION HYDRATION RETURN IF STREAM FORCE DECLINESRETURN IF STREAM FORCE DECLINES HEMATURIA DOES NOT RESOLVEHEMATURIA DOES NOT RESOLVE


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