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Senior - Emed 4 > 3 - Abdominal Trauma > Flashcards

3 - Abdominal Trauma Flashcards

1
Q

Abdominal trauma accounts for?

A

15-20% of all trauma deaths

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2
Q

You survived the initial abdominal injury, now what kills you?

A

Sepsis

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3
Q

MCC of blunt abdominal trauma?

A

MVC

Falls can do it too

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4
Q

Typical blunt intra-abdominal trauma is?

A

Hollow viscous rupture

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5
Q

Penetrating abdominal injury considerations?

A

Bullets:

  • cavitation injury
  • secondary missiles (bone etc)

Stab/FOB:
- length, trajectory and frag may be ukn during initial eval

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6
Q

Assume penetrating abdominal trauma with:

A

Any injury to:

  • lower chest
  • pelvis
  • flank
  • back

Is considered penetrating injury until proven otherwise

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7
Q

Problem with abdominal injuries (and really most inj) with young healthy pts?

A

They compensate for intra-abdominal hemorrhage before clinical signs become overt

They compensate, compensate, compensate, die

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8
Q

Symptoms of abdominal contusion?

A

Pain w flexion, rotation
Focal tenderness
Hematoma
- Palpable mass inferior to umbilicus

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9
Q

S/s of solid organ damage?

A

Gen due to blood loss

  • increase in pulse pressure
  • pain and bleeding may be minimal
  • delayed rupture is a thing with liver and spleen
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10
Q

= 15% blood loss presentation?

A

Can have increased pulse pressure as the only clue

- be cautious w sig MOI and increased pulse

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11
Q

Spleen and liver inj presentation?

A

Spleen - may refer to L shoulder/arm

Liver - may refer to right shoulder

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12
Q

What is a condition that predisposes people to splenic inj?

A

Pregnancy
Mononucleosos
Bicycles

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13
Q

In blunt abd trauma, 5% incidence of?

A

Blunt bowel and mesenteric injuries

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14
Q

Hollow viscus injuries produce what symptoms?

A

Combination of:

  • blood loss
  • peritoneal contamination w/ GI contents
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15
Q

Hemorrhage from mesenteric inj?

A

May be minimal and easily missed on PE

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16
Q

Chemical irritation of peritoneum presentation?

A

Gastric acid contents may produce:

  • immediate pain
  • But bacterial contamination may delay s/s
  • delays increase mortality
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17
Q

Previlence of pancreatic injuries?

A

4% of abd trauma

- but sig morbidity and mortality

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18
Q

S/s of pancreatic inj?

A

No specific but look for:

  • MOI - rapid deceration
  • no seatbelt, bicycle handle bars
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19
Q

Duodenal inj?

A

Relatively asymptomatic

  • small hematoma of duodenum may go undiagnosed
  • gastric outlet obstruction developes as it expands
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20
Q

When to consider duodenal rupture?

A

High-veolicity deceleration events where intraluminal pressure of pylorus and proximal small bowel rapidly increases

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21
Q

Delayed presentation of duodenal rupture?

A

Fever and leukocytosis herald the development of sepsis

22
Q

What happens when you knock the wind out of a pt?

A

Diaphragm spasms (2/2 blow to epigastrium)

  • difficulty breathing
  • diaphragm cannot relax
  • lungs cannot expand
  • relaxes slowly
23
Q

Diaphragmatic rupture

A

Rare (0.8-5%) of pts with thoracoabdominal inj

- left sided phenomenon

24
Q

What if you miss a diaphragmatic injury?

A

May lead to:

  • delayed herniation
  • strangulation of abdominal contents through defect
25
Q

How are intra-abdominal injuries diagnosed?

A 
No gold standard but:
- PE
- Lab analysis
- Imaging 
- Repeated exams
(The cost of missing one is high, so be careful)
26
Q

US on abdominal trauma?

A

FAST

- rapid identification of free intraperitoneal fluid in the hypotensive pt w blunt abdominal trauma

27
Q

Advantages of FAST?

A 
Accurate
Rapid (<4min)
Noninvasive
Repeatable
Portable 
No nephrotoxic or ionizing exposure
28
Q

Massive hemoperitoneum can be quickly identified by looking in? (FAST)

A

Morrison’s pouch

82-90% of hypotensive pts

29
Q

Advantage of FAST over diagnostic peritoneal lavage (DPL)

A

Fast evaluates for

  • free pericardinal/pleural fluid
  • pneumothorax
30
Q

Limitation of FAST vs CT?

A

CT can id exact source of free intraperitoneal fluid
- may change w adoption of contrast enhanced US (sounds fancy)

CT can eval retroperitoneum better

So consider FAST and CT complementary rather than competing

31
Q

Disadvantages of FAST?

A

Operator-dependent nature of exam

difficult in:

  • obese
  • sub Q air
  • excessive bowel gas

Cannot differentiate between intraperitoneal hemorrhage and ascites

32
Q

Uses for US other than FAST?

A

Guide suprapubic catheter placement

Measure inferior vena cava diameter

  • marker of intravascular volume
  • predictor of mortality
33
Q

Because FAST can detect small amounts of free intraperitoneal fluid it can?

A

Estimate rate of hemorrhage through serial exams

34
Q

A positive DPL in isolation is no longer

A

Absolute indication for exploratory laparotomy

35
Q

Noninvasive gold standard study for diagnosis of abdominal injury?

A

Abdominopelvic CT w IV contrast

36
Q

Advantages of CT for abdominal trauma?

A

Precise locations and grade of inj can be id’d

Quantify and differentiate amount and type of free fluid in abdomen

Eval retroperitoneal inj
- makes it ideal for duodenum and pancreas

37
Q

Disadvantages of CT?

A

Ionizing radiation

Must leave trauma bay

38
Q

Locally explore anterior abd stab wounds to

A

Assess for violation of peritoneum

39
Q

Gold standard therapy for significant intra-abdominal injuries?

A

Laparotomy

  • rarely misses an inj
  • allows for complete eval
40
Q

Who needs surgical exploration?

A

All pts w

  • persistent HOTN,
  • abdominal wall disruption
  • peritonitis
41
Q

Absolute indications for laparotomy

- blunt trauma

A
  • Anterior abdominal inj w HOTN
  • Abdominal wall disruption
  • Peritonitis
  • Free air under diaphragm
  • Pos FAST/DPL in hemodynamically unstable pt
  • CT says you need it
42
Q

Absolute indications for laparotomy

- penetrating inj

A
  • Inj to abdomen, back, flank w HOTN
  • abd tenderness
  • GI evisceration
  • high suspicion for abd GSW
  • CT says you need it
43
Q

Relative indications for laparotomy

- blunt trauma

A
  • Pos FAST/DPL in hemodynamically stable pt
  • solid visceral inj (stable pt)
  • hemoperitoneum on CT w/o clear source
44
Q

Relative indications for laparotomy

- penetrating trauma

A

Pos local wound exploration after stab wound

45
Q

Ct can grade visceral injuries, how does this predict success

A

CT grading may not agree w intraoperative observation and does not always predict the success of nonoperative management

46
Q

WTF is REBOA?

A

Resuscitave endovascular balloon occlusion of the aorta

- endovascualr balloon occlusion of the aorta

47
Q

REBOA is a percutaneous method to?

A
  • Achieve temp occlusion of aorta
  • Maintain/increase perfusion to heart and lungs in setting of shock
  • Avoid thoracotomy for proximal aorta control
48
Q

For the purposes of REBOA, how is the aorta divided?

A

3 zones

  • I: descending thoracic aorta (between origin of L subclavian and celiac arteries)
  • II: between celiac and lowest renal artery
  • III: lowest renal artery and aortic bifurcation
49
Q

How long can REBOA be left in?

A

60 min is tolerated well and recoverable

50
Q

Return instructions for abd inj?

A

If you develop:

  • fever
  • vomiting
  • increased pain
  • blood loss s/s

Return promptly to ED

51
Q

What do you call cheese that is not yours?

A

Nacho Cheese

Senior - Emed 4 (6 decks)

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