5 - Abdominal And GU Flashcards
Anterior abdomen stuff:
Spleen
Liver
Colon
Small intestine
Retroperitoneum
Duodenum Pancreas Kidneys Aorta Vena cava
Why get imaging with abdominal trauma?
To ensure no solid organ injury
Plain films
FAST
CT
If penetrating abdominal injury, need to do:
Exploratory surgery - either laparotomy or laparoscopy
Primary and secondary survey for abdominal injury will include:
Head to toe physical IV access Resuscitation and IVF Monitor/VS Meds (pain, nausea, ABX, Td) NG/OG tube, urinary cath Urgent procedures (i.e. thoracostomy)
Signs that indicate higher likelihood of need for surgery
Seat belt sign Boot tread marks Tire mark Grey-Turner Sign Cullen Sign
ANY penetrating trauma:
Goes to OR to evaluate for hollow viscous organ injury and/or exploratory surgery
If epigastric, make sure to evaluate chest wall with CXR
What is an evisceration injury?
Abdominal contents outside the abdominal wall
Do NOT shove them back in
Cover with a clean, wet dressing
Straight to the OR
Does the presence of bowel sounds r/o intra-abdominal injury?
Nope
And the absence of them doesn’t prove injury, either
Ileus can be caused by many things:
Hypovolemia Tension PTX Cardiac tamponade Peritonitis Lumbar spine injury
Dullness to percussion may be a sign of:
Intraperitoneal bleeding
Should i probe stab wounds in the ED?
NO!
Stab wounds - if fascia is intact:
No formal surgery needed
When would you not want to insert an NG tube?
Basilar skull / cribiform plate fracture
Evaluating pelvic trauma
Rock the pelvis ONCE (pressure laterally and to the pubic symphysis)
Pain may also be 2/2 lumbar fx or femur fx
If you suspect urethral injury:
Do a RUG prior to insertion of foley
If there’s hematuria:
Txt with IV fluid to flush the blood out of the urinary tract while you figure out where the bleeding is coming from
Basic test to order:
CBC (H and H)
CMP
UA
Amy/Lip if pancreatic injury suspected
Imaging in abdominal and pelvic trauma
CXR (rib fx, PTX, hemothorax, mediastinal widening)
ABD (hemoperitoneum)
Pelvis (fractures, hemorrhage from pelvic injury can be significant; bladder inj)
FAST
A decision-point tool
Just looking for fluid
Doesn’t isolate the bleeding source
Limitations of CT
Can miss hollow viscous injury
May show “fat stranding,” pneumoperitoneum and free fluid as sequelae of hollow viscous organ injury
If blunt abd trauma and no hemorrhage suspected:
Monitor, txt non-operatively
Serial abdominal exams
Anemia of investigation 😂
If blunt abd trauma and hemorrhage confirmed:
Still may monitor if hemodynamically stable
Take to OR urgently if hemodynamically unstable
MC’ly injured = liver and spleen
Txt of penetrating abd trauma:
To OR for exploratory surgery
MC’ly injured = liver and spleen
abdominal compartment syndrome
Massive trauma requiring fluid resuscitation
If closed, abdomen 3rd-spaces fluid + edema
May lead to end organ failure
Bowel necrosis -> peritonitis -> sepsis -> shock -> death
Increased fascial tension -> dehiscence, incisional hernia or evisceration
Txt for abd compartment syndrome
Open em up, let it drain out
Low suction
After edema subsides and fluid mobilized, abdomen closed free of tension
Post-operative care:
Drains
Jackson Pratt - grenade-shaped vacuum container, closed system under suction
Penrose - rubber/latex, not under suction, prevents wound healing and allows serous drainage
Methods to stabilize pelvic fractures
Skin traction Sheet/pelvic binder PASG (fancy pants) MAST (less fancy pants) External fixation (ortho surgery)
If urethral injury, how do we drain the bladder?
Suprapubic catheterization (done by urology)
Where do you learn to make ice cream?q
Sunday School 🍨
