ABSITE Trauma Questions | 100% Correct Answers | Verified | Latest Update 2024

A 34-year-old female presents after a high-velocity MVC with right flank pain and frank bright red blood in her urine. Her primary survey is intact, and vital signs are HR 112 bpm, BP 86/59 mmHg, RR 20/min, and oxygen saturation is 98% on room air. CT scan demonstrates a Grade IV laceration to the right kidney. The best choice for management is: A. Renorrhaphy B. Packing of the renal fossa, temporary abdominal closure, and return to the ICU. C. Total nephrectomy D. Observation in the intensive care unit with blood transfusion as needed E. Gelfoam angioembolization - Renorrhaphy Correct. This patient is hemodynamically unstable, and therefore should be taken to the operating room for laparotomy and renal exploration. Principles of operative repair for a Grade IV, and for some Grade V kidney lacerations include renal preservation, when possible—debridement of non-viable tissue, hemostasis using absorbable sutures in a figure-of-eight fashion with care taken to preserve arterial supply to distal segments, closure of the collecting system with absorbable suture in a running fashion, and reapproximation of the capsule. An omental flap can be substituted for large defects if necessary. Damage control laparotomy is not indicated in this patient in the absence of coagulopathy, hypothermia, or acidosis.