In case of pelvic fracture with urethral injury, the most impoant first step in management is?
**Core Concept**
In the setting of a pelvic fracture with urethral injury, it is crucial to prioritize the prevention of further injury and complications, particularly to the genitourinary tract. The urethra is prone to injury due to its anatomical location and the high forces involved in pelvic fractures.
**Why the Correct Answer is Right**
The most important first step in managing a pelvic fracture with urethral injury is to perform a retrograde urethrogram (RUG). This diagnostic imaging test involves the instillation of a contrast agent into the urethra through the meatus, allowing for visualization of the urethral lumen. A RUG is essential in identifying the location and extent of the urethral injury, guiding further management decisions. In the absence of a RUG, attempts at catheterization may exacerbate the injury, leading to severe complications such as urethral stricture or fistula formation.
**Why Each Wrong Option is Incorrect**
**Option A:** Insertion of a Foley catheter without prior imaging is incorrect because it may worsen the urethral injury, leading to complications.
**Option B:** Administration of antibiotics alone is insufficient as a first step in management, as it does not address the underlying urethral injury.
**Option C:** Immediate surgical repair of the pelvic fracture is incorrect because it does not prioritize the assessment and management of the urethral injury.
**Clinical Pearl / High-Yield Fact**
In cases of pelvic fracture with suspected urethral injury, a RUG should be performed before attempting any invasive procedures, including catheterization or surgical repair.
**Correct Answer:** C.