![]() the findings on DRE have poor inter-observer agreement.a ‘high riding prostate’ may be concealed by hematoma formation from a coexistent pelvic fracture or vessel injury.examination may be limited by tenderness and poor cooperation.before the diagnosis of posterior urethral disruption was confirmed by some other means…) positive findings on DRE are rare… anyone ever felt a ‘high riding’ prostate?… (i.e.either because it is considered a menial task, or so that the junior staff ‘gain more experience’. DREs are often performed by junior staff.80% for abnormal position of the prostate.67% for disruption of the rectal wall integrity.94% for the presence of gross rectal blood.Shlamovitz et al (2007) found high rates of falsely negative DREs: the occurrence of false positive and false negative DRE findings.unstable pelvic fracture, rectal defects) and also risk of injury to the clinician (e.g. injury - potential for worsening of the patient’s injuries (e.g.contamination of local wounds risk of transmission of infection to the clinician (likely to be extremely low) risk of verbal and/ or physical violence from an agitated patient.tenderness from ruptured viscus or intraperitoneal hemorrhage.a high riding prostate suggestive of posterior urethral disruption.loss of anal tone suggesting spinal cord injury.The DRE is not a useful screening test in trauma patients (detects DRE rarely changes the management of trauma patients (0 to 4% of cases).The 8th edition of ATLS recommends that ‘DRE be performed selectively before inserting an indwelling urinary catheter’.Traditional ATLS teaching was that a digital rectal exam (DRE) is mandatory in trauma patients: “a finger or tube in every orifice”.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |