Mild traumatic brain injury (mTBI) is a common pathological condition in emergency medical care. Although most mTBI cases resolve in a few days, some deteriorate to a serious state that may lead to a poor outcome. Social problems, such as postconcussional syndrome and higher brain dysfunction, also accompany neurotrauma. In this paper, we discuss important topics in clinical management of mTBI while referring to the guidelines for the treatment and management of traumatic brain injury (4th edition, published in 2019).
In clinical management of mTBI, it is important to consider the risk factors of aggravation, judge indications on CT, and decide whether hospitalization is needed. In addition, detailed medical records are important for future reference in the diagnosis of postconcussional syndrome or higher brain dysfunction.
Pelvic fracture urethral injury (PFUI) in men is an uncommon yet debilitating consequence of blunt pelvic trauma. Its mechanism involves major shearing forces at the bulbomembranous urethral junction, resulting in avulsion of the urethra from the fixed urogenital diaphragm. When the pelvis is fractured, the patient often exhibits blood at the urethral meatus, inability to void, bladder distension, and perineal hematoma, which are signs of urethral injury. For unstable patients, the physician may attempt placement of a urethral catheter followed by a suprapubic tube (SPT) if placement failed. Retrograde urethrography should be performed to characterize potential urethral injuries in stable patients. If urethral injury is indicated, primary realignment (PR) of the urethra over a urethral catheter may be performed instead of SPT placement. However, even when PR is successful, most patients will develop urethral stenosis during the first year after injury. The gold standard management for urethral stenosis is delayed urethroplasty performed three to six months after the trauma. When performed using the proper technique, delayed urethroplasty has a high success rate and a low complication rate. In this article, the keys to the management of PFUI are reviewed.