Evidence-Based Management Of Pediatric Genitourinary Tract Injuries In The ED

Arpilleda, Joyce C. MD, FAAP
Abramo, Thomas MD, FAAP, FACEP
Wiebe, Robert A. MD

¹Authors
²Associate Clinical Professor of Pediatrics, Rady Children's Hospital and Health Center, University of California San Diego, San Diego, CA
³Peer Reviewers
⁴Professor of Emergency Medicine and Pediatrics; Director, Pediatric Emergency Department, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
⁵Professor, Division of Pediatric Emergency Medicine, University of Texas, Southwestern Medical Center at Dallas, Dallas, TX

Date of original release: May 1, 2010

Date of most recent review: April 10, 2010

Termination date: May 1, 2013

Medium: Print and Online

Method of participation: Print or online answer form and evaluation

Prior to beginning this activity, see “Physician CME Information” on page 15.

Pediatric Emergency Medicine Practice 7(5):p 1-13, May 2010.

An 11-year-old female presents with abdominal pain, vomiting, and left arm pain after being injured by a horse. The horse was standing on the patient's right side when it was spooked and bumped into her. She fell to the ground but was not sure whether or not she had been directly kicked by the horse. Vomiting and abdominal pain developed after she was back at home, approximately 30 minutes after the incident. Upon her arrival at the triage area of the ED, the patient discovered that she had gross hematuria. Her initial vital signs on triage included a blood pressure of 106/60 mm Hg, a heart rate of 90 beats per minute, and a respiratory rate of 20 breaths per minute. Physical examination revealed pallor during retching, a chin abrasion, a horseshoe-shaped contusion over the right lateral ribs, and tenderness in the abdominal right upper quadrant and right flank. Bilateral peripheral intravenous catheters were placed, and 0.9% normal saline solution (20 mL per kg of body weight) was administered in the ED.

What are the priorities in the initial evaluation and management of this child? How would you evaluate this possible renal injury?