By T. Giores. Grambling State University.

The diagnosis is best established uti- myoglobin in rhabdomyolysis or the exogenous lizing IVP and retrograde pyelogram buy 400mg uniphyl cr with amex. Indications for dialysis include the BLADDER need for ultrafiltration of a volume-overloaded state or the need for solute clearance discount uniphyl cr 400mg mastercard. Patients with bladder contusion present with a history of trauma, GENITOURINARY TRAUMA suprapubic pain, guarding, hematuria, and possibly dysuria. RENAL Bladder rupture may be intra- or extra-peritoneal and is usually associated with pelvic fracture. A blow to the cling and presents with abrupt onset of urinary fre- flank or abdomen produces a coup or countercoup quency, diminished urinary stream, nocturia, and mechanism of injury. Bladder contu- Kidney injuries are divided into 5 classes based on sions are treated with catheter drainage for a few days. Class II: Cortical laceration Class III: Caliceal laceration Class IV: Complete renal fracture—rare sports injury GENITALIA Class V: Vascular pedicle injury—again, rare in sports Flank pain or gross hematuria after blunt trauma in an Genital trauma may occur in any sport, though it’s athlete requires consideration of possible renal injury. Gross or microscopic hematuria is present Testicular injuries result from direct trauma and in greater than 95% of renal trauma. Other urologic emergency requiring surgical management if sports to include in this category are basketball, the testis is to be salvaged. The penis majority of sports-related eye injuries (Napier et al, may be injured in straddle-type injuries or by direct 1996). Irritation of the pudendal nerve in bicycle racers can cause priapism or ischemic neuropathy of the penis. Symptoms usually resolve once the race PREPARTICIPATION PHYSICAL is over. EXAMINATION Penile frostbite occurs in runners who wear inade- quate clothing in extremely cold conditions. Gerstenbluth RE, Spirnak JP, Elder JS: Sports participation and using protective eyewear, participating in sports high grade renal injuries in children.

These are very helpful to elevate limbs purchase 400 mg uniphyl cr fast delivery, providing good access during excision and grafting buy 400mg uniphyl cr amex. Operating rooms should have also a second operating table available for turning the patient when it is necessary to place patients in the prone position for harvesting donor sites from the back or to perform excision and grafting of burns on the back. The second operating table should be an ordinary table with hydraulic capabilities. This is normally used when minor burns are treated and full body prepping is not necessary. Arm tables and any other operating table accessories must be available to perform minor burn operations. It permits total body prepping and easy access for both surgeons and anesthetists. It also avoids the need for assistants to hold limbs, so the operating team does not become exhausted. The burns operating team is very numerous and the equipment required for major burn wound excision is extensive. Large and spacious rooms help to run the operation smoothly and allow circulating nurses and other assistants to perform their duties at easy and not interfering with the operating team. The room should also include individual thermostats to keep the room temperature at 32 C. Above this temperature, the energy source for evaporation will come from the environment rather than the patient. In this situa- tion, patients become hypothermic and their metabolic rate increases. In extreme circumstances, patients are at risk of death from hypothermia.

Classification Various classifications have been proposed for proximal 3 discount uniphyl cr 400mg line. The classification Teratological hip dislocation most commonly used is that of Aitken (⊡ Fig cheap 400 mg uniphyl cr free shipping. This is a purely radiological classification and thus in- > Definition complete. The condition frequently has to be reclas- Dislocation of one, or usually both, hips at birth as a sified during the course of growth. A comprehensive result of malformations rather than immaturity of the classification of congenital anomalies of the femur has joints, and associated with other deformities. More Occurrence recently Paley proposed a classification with 3 types Since teratological hip dislocation is not a systemic illness (⊡ Table 3. In particular, these techniques ring deformities are: can show whether a femoral head is present or not, a find- Torticollis, plagiocephaly (32%), arthrogryposis, ing that is important for correct classification. Larsen syndrome, general ligament laxity, flat feet, club feet, proximal femoral focal deficiency, congenital Occurrence knee dislocation, pyloric stenosis, renal agenesis and or- The incidence of proximal femoral focal deficiency cal- chidocele. Compared to dysplasia-related hip dislocation, culated in an epidemiological study was found to be 2 teratological dislocation of the hip is extremely rare. If all femoral anomalies are taken into account, the frequency is undoubtedly much Diagnosis greater since mild forms of femoral hypoplasia in par-! If an abnormality of any kind exists at birth, an ticular are very numerous and usually not yet diagnosed ultrasound scan of the hips is invariably indicated. Classification of a proximal focal femoral deficiency (PFFD) (I–IX) accord- ing to Pappas (see text) ⊡ Table 3. Classification of congenital femoral anomalies of the femur after Pappas deficiency (CFD) after Paley Class Characteristics Type I Complete absence of the femur 1 Intact femur with mobile hip and knee a) normal ossification of proximal femur II Proximal femoral deficiency combined with lesion of b) delayed ossification of proximal femur the pelvis 2 Mobile pseudarthrosis (hip not fully formed, a false III Proximal femoral deficiency without bone connection joint) with mobile knee between the femoral shaft and head a) femoral head mobile in acetabulum IV Proximal femoral deficiency with poorly organized b) femoral head absent or stiff in acetabulum fibro-osseous connection between the femoral shaft 3 Diaphyseal deficiency of femur (femur does not reach and head the acetabulum) V Femoral deficiency in the middle of the shaft with a) knee motion > 45° hypoplastic proximal or distal bony development b) knee motion < 45° VI Distal femoral deficiency VII Hypoplastic femur with coxa vara and sclerosis of diaphysis VIII Hypoplastic femur with coxa valga IX Hypoplastic femur with normal proportions 227 3 3.