This evaluation should consist of a head to toe physical examination with a reevaluation of vital signs and resuscitative efforts. This chapter section is tailored to a focused abdominal examination and should not preclude a complete physical exam. Note any impaled foreign bodies. Also inspect for contusions, abrasions, and lacerations. Vaginal bleeding in the pregnant patient warrants early consultation with an obstetrician and general surgeon.
Caution is recommended when facial fractures are suspected.
Placement should be directed through the mouth with efforts aimed at avoiding unintentional intracranial insertion. An examination of genitalia and a rectal exam should be performed before insertion of the catheter. Contraindications to placement include blood at the meatus, scrotal hematoma, and a high riding prostate. Local wound exploration may be considered for stab wounds. If anterior fascial penetration is found, then abdominal penetration must be presumed.