Chest injury as part of major trauma, can range from painful to life threatening so prompt treatment and recognition is vital. Esp. in ‘Silver Trauma’ when ‘minor’ injuries may have devastating consequences – the full guidance can be found @WYMTN – HERE
Referral
The first point of contact for urology advice and referral is the general surgical SHO. This is the on-call surgical SHO carrying the on-call bleep. Some of the on call general surgical SHO have a urology background.
If a time critical emergency such as torsion is presenting, then the first point of contact should be the urology registrar.
In the case of Urological/Surgical emergency
- Refer directly to Middle Grade on-call
- If Middle Grade unavailable/uncontactable – Contact speciality consultant on-call
- If NO senior available – inform ED senior
- Admit directly (admission rights) to SAU/Ward 4 HRI
- Attempt to contact surgical SHO (to inform)
(agreed with both surgical and urological leads)
Under 3’s go to Leeds
Urologist are happy to operate on patients over the age of 3 years old. Under the age of 3 if this on a urological emergency such as a torsion then this patient should be referred to Leeds paediatric urology services.
Streaming
Any patent with a post op complication for up to 7 days form urological procedure – should be streamed directly to the urology team via the surgical SHO. If the patient is unwell and needs resuscitation and immediate management for example sepsis, then ED team needs to be involved in resuscitation measures and the urological registrar needs to be involved as well
Pyelonephritis
Currently ALL Pyelonephritis should be admitted under the urology team. There is a conversation between urology and medical teams happening currently to see if that requires further rationalisation. However currently the position is all pyelonephritis patients who need admitting are done so under the urology team.
- Uncomplicated pyelonephritis – does not require CT scanning or ultrasound scanning from the emergency department.
- Suspicion of an obstructive uropathy – CT KUB needs to be arranged from the ED
Investigations including:
- FBC
- U&E, CRP
- Blood Cultures
- Urine cultures
Appropriate Antibiotics should be prescribed using the current antibiotic guidelines.
Renal Colic
CTKUB are now available 24/7.
Patient presenting >50 years old with a renal colic story, should have a ultrasound scan done at the bedside to ensure that there is no aortic aneurysm before being sent for a CT KUB.
Uncomplicated renal colic needs a non contrast CT scan. This should be organised by the ED
Uncomplicated renal colic patients can wait CT KUB for results on SDEC. (The case must be to be discussed with the surgical SHO on-call and accepted by them before transfer of the patient. SDEC closes at 6 pm)
Haematuria
All frank hematuria needs investigation
- Admit + 3-way catheter – those at risk of clot retention and shock
- Hb <100
- Post void bladder scan>250 ml
- All those discharged: will need a OPD cystoscopy arranged as well as a USS (the request for flexible cystoscopy on EPR is Urol Cystoscopy post Wd Dis)
Catheters
New catheters and catheter complications – follow current guidelines. Community nurses follow up for TWOC or other catheter care (HOUDINI team in Kirklees)
