C10029324 / invoice 10000

REASON Blocked bladder

HISTORY: Previous Hx of  cystitis 

EXAMINATION:  Heart Rate 192
              Resp Rate 24
              MM pink
              CRT 1s
Appears bright and alert. Obviously distended bladder. Straining to pass urine passing very small amounts only
Recommended GA to catheterise  and flush bladder 


DIFFERENTIAL DIAGNOSIS

LAB Pre GA biochem all normal . No azotemia 

TREATMENT   GA Acp/methone Alfaxan/ISO/O2 
  Drained 20ml from bladder by cysto 
Clipped and prepped skin.
 Used an open ended catheter to clear obstruction using a combination of sterile lubricant gel and saline and reverse hydropulsion .
Drained bladder. 
Flushed bladder multiple times by filling with saline then draining through catheter 
Filled bladder again and removed catheter expressed bladder to a good stream and flushed a significant amount of whitish sand like material from urethra. Repeated process until clear .
Placed slippery Sam catheter  and sutured in place with 5/O Radik (vicryl)

i/v Hartmenns during and post operatively 

Urinalysis : USg >1.050 2+ Protein 3+ blood ,pH 7 Micro -> no obvious crystals.  in urine sample whitish grainy material appears to be Uric Acid crystals  (google search) no obvious bacteria, small amount blood only

X ray post op -> good placement oof catheter, no obvious stones

Meloxicam inj   on wake up 

9pm.  BAR. Eating ,  Catheter appears to be flowing well./ Replaced pad 

Prazosin 1mg x 1/2 bid  x 5d  to start tomorrow morning

PLAN Remove  i/v catheter  Thursday morning  if all going well
Plan to leave urinary catheter in place for 48h, removing on Friday morning  
Will give antibiotics on removal