If the patient is severely injured or is stable but cannot urinate, a catheter should be inserted into the bladder after ascertaining that there is no evidence of a urethral injury (such as blood at the urethral meatus, penile or scrotal hematomas, or a displaced prostate on rectal examination).
A gastric tube is inserted to reduce gastric distension and the chances of aspiration. Blood in the gastric aspirate may represent oropharyngeal (swallowed) blood, traumatic insertion, or actual injury to the esophagus or stomach. Deviation of a nasogastric tube to the right in the middle or upper chest on a chest radiograph suggests a traumatic rupture of the aorta. If the end of the tube enters the abdomen and then goes up into the chest, it suggests a diaphragmatic rupture.
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