A 3 year-old male castrated indoor/outdoor Domestic Shorthair presented to the Emergency Service for trauma of unknown origin. He was admitted and managed according to the Trauma Assessment and Immediate Resuscitation Algorithm, an assessment protocol dictating the identification and resuscitation of polytrauma. His external assessment revealed a 7 cm laceration on the proximal medial thigh and a crepitus of the distal tibia appreciated on palpation. His physical exam was consistent with hypovolemic shock, so he was given a Plasma-lyte 10 mL/kg bolus over 20 minutes (12% shock dose) then started on P-lyte at 17 mL/hr.
Preliminary blood work revealed an elevated blood urea nitrogen of 50-80 mg/dL. His Gaslyte was consistent with a metabolic acidosis without respiratory compensation, in addition to hypocalcemia, hyponatremia, and hypochloremia. Thoracic and abdominal focused assessment with sonography for trauma showed a few B-lines on the left and showed no free abdominal fluid. As initial management, he was started on fentanyl 3 mcg/kg/hr CRI, 30 mg/kg ampicillin/sulbactam, and heat support. The laceration was lavaged and aseptically bandaged. External coaptation in the form of a Modified Robert Jones bandage was applied to the left pelvic limb. His chemistry panel, run the following day, was consistent with renal or post-renal azotemia. Microscopic evaluation of the urinalysis sediment demonstrated moderate numbers of large polygonal to rectangular cells with pink grainy cytoplasm interpreted as squamous origin. A repeat AFAST demonstrated fluid in the cystocolic region. A sediment analysis of the peritoneal fluid contained polygonal cells nearly identical to the cells from the urinalysis, suggesting that the bladder and peritoneum were in communication. The peritoneal fluid creatinine concentration was elevated, consistent with a uroabdomen. Urethral catheterization was unsuccessful. Contrast cystourethrography was performed, which demonstrated opacification of the abdominal cavity with no detectable contrast in the bladder lumen. This report will discuss the assessment and management of polytrauma patients, emphasizing the algorithmic approach necessary to identify and prioritize problems.