5 - Abdominal And GU

Question 1

Anterior abdomen stuff:

Answer 1

Spleen
Liver
Colon
Small intestine

Question 2

Retroperitoneum

Answer 2

Duodenum
Pancreas
Kidneys
Aorta
Vena cava

Question 3

Why get imaging with abdominal trauma?

Answer 3

To ensure no solid organ injury

Plain films
FAST
CT

Question 4

If penetrating abdominal injury, need to do:

Answer 4

Exploratory surgery - either laparotomy or laparoscopy

Question 5

Primary and secondary survey for abdominal injury will include:

Answer 5

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)

Question 6

Signs that indicate higher likelihood of need for surgery

Answer 6

Seat belt sign
Boot tread marks
Tire mark
Grey-Turner Sign
Cullen Sign

Question 7

ANY penetrating trauma:

Answer 7

Goes to OR to evaluate for hollow viscous organ injury and/or exploratory surgery

If epigastric, make sure to evaluate chest wall with CXR

Question 8

What is an evisceration injury?

Answer 8

Abdominal contents outside the abdominal wall

Do NOT shove them back in

Cover with a clean, wet dressing

Straight to the OR

Question 9

Does the presence of bowel sounds r/o intra-abdominal injury?

Answer 9

Nope

And the absence of them doesn’t prove injury, either

Question 10

Ileus can be caused by many things:

Answer 10

Hypovolemia
Tension PTX
Cardiac tamponade
Peritonitis 
Lumbar spine injury

Question 11

Dullness to percussion may be a sign of:

Answer 11

Intraperitoneal bleeding

Question 12

Should i probe stab wounds in the ED?

Answer 12

NO!

Question 13

Stab wounds - if fascia is intact:

Answer 13

No formal surgery needed

Question 14

When would you not want to insert an NG tube?

Answer 14

Basilar skull / cribiform plate fracture

Question 15

Evaluating pelvic trauma

Answer 15

Rock the pelvis ONCE (pressure laterally and to the pubic symphysis)

Pain may also be 2/2 lumbar fx or femur fx

Question 16

If you suspect urethral injury:

Answer 16

Do a RUG prior to insertion of foley

Question 17

If there’s hematuria:

Answer 17

Txt with IV fluid to flush the blood out of the urinary tract while you figure out where the bleeding is coming from

Question 18

Basic test to order:

Answer 18

CBC (H and H)
CMP
UA

Amy/Lip if pancreatic injury suspected

Question 19

Imaging in abdominal and pelvic trauma

Answer 19

CXR (rib fx, PTX, hemothorax, mediastinal widening)

ABD (hemoperitoneum)

Pelvis (fractures, hemorrhage from pelvic injury can be significant; bladder inj)

Question 20

FAST

Answer 20

A decision-point tool

Just looking for fluid

Doesn’t isolate the bleeding source

Question 21

Limitations of CT

Answer 21

Can miss hollow viscous injury

May show “fat stranding,” pneumoperitoneum and free fluid as sequelae of hollow viscous organ injury

Question 22

If blunt abd trauma and no hemorrhage suspected:

Answer 22

Monitor, txt non-operatively

Serial abdominal exams

Anemia of investigation 😂

Question 23

If blunt abd trauma and hemorrhage confirmed:

Answer 23

Still may monitor if hemodynamically stable

Take to OR urgently if hemodynamically unstable

MC’ly injured = liver and spleen

Question 24

Txt of penetrating abd trauma:

Answer 24

To OR for exploratory surgery

MC’ly injured = liver and spleen

Question 25

abdominal compartment syndrome

Answer 25

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

Question 26

Txt for abd compartment syndrome

Answer 26

Open em up, let it drain out

Low suction

After edema subsides and fluid mobilized, abdomen closed free of tension

Question 27

Post-operative care:

Answer 27

Drains

Jackson Pratt - grenade-shaped vacuum container, closed system under suction

Penrose - rubber/latex, not under suction, prevents wound healing and allows serous drainage

Question 28

Methods to stabilize pelvic fractures

Answer 28

Skin traction
Sheet/pelvic binder
PASG (fancy pants)
MAST (less fancy pants) 
External fixation (ortho surgery)

Question 29

If urethral injury, how do we drain the bladder?

Answer 29

Suprapubic catheterization (done by urology)

Question 30

Where do you learn to make ice cream?q

Answer 30

Sunday School 🍨