Urogenital trauma

Abstract

Urological SurveyAs we can see all efforts are been doing now by radiologists in order to perform a low-dose CT protocol. While acquiring thin slices with high spatial resolution, we can reduce the dose to similar values as in conventional radiography, especially when examining under high-contrast conditions. Using all these various options available, radiation exposure can sometimes even be lower than using a conventional single-slice helical CT. By using low dose-CT protocol we can reach similar sensitivity, specificity and accuracy. For the detection of urolithiasis, for example, low dose CT protocol is superior to IVU and confers a total dose of 2.8 mSV, which is about double that for IVU and about 75% and 50% of that for non-optimized UHCT protocols. Recently these low dose noncontrast CT protocols has been shown to be useful also for the diagnosis of stones in pregnant women and children. Surg. 2003; 197: 697 Background: Tachycardia is believed to be closely associated with hypotension and is often listed as an important sign in the initial diagnosis of hemorrhagic shock, but the correlation between heart rate and hypotension remains unproved. Dr. Adilson PrandoStudy Design: Data were collected from all trauma patients, 16 to 49 years old, presenting to our university-based trauma center between July 1988 and January 1997. Moribund patients with a systolic blood pressure < or =50 or heart rate < or = 40 and patients with significant head or spinal cord injuries were excluded. Tachycardia was defined as a heart rate > or = 90 and hypotension as a systolic blood pressure < 90.Results: Hypotension was present in 489 of the 14,325 admitted patients that met the entry criteria. Of the hypotensive patients, 35% (169) were not tachycardic. Tachycardia was present in 39% of patients with systolic blood pressure 120 mmHg. Hypotensive patients with tachycardia had a higher mortality (15%) compared with hypotensive patients who were not tachycardic (2%, P = 0.003). Logistic regression analysis revealed tachycardia to be independently associated with hypotension (p = 0.0004), but receiver operating curve analysis demonstrated that the sensitivity and specificity of heart rate for predicting hypotension is poor.Conclusions: Tachycardia is not a reliable sign of hypotension after trauma. Although tachycardia was independently associated with hypotension, its sensitivity and specificity limit its usefulness in the initial evaluation of trauma victims. Absence of tachycardia should not reassure the clinician about the absence of significant blood loss after trauma. Patients who are both hypotensive and tachycardic have an associated increased mortality and warrant careful evaluation.