5. Abdominal and Pelvic Injury

Question 1

In order, the most common organs injured in abdominal blunt trauma:

Answer 1

Spleen
Liver
Small bowel

Question 2

When should you place a urinary catheter?

Answer 2

Wait until after FAST is done (FAST works best with a full bladder)

Question 3

When should you use DPL

Answer 3

Generally speaking, only if FAST and/or CT are not available.

Only doen after bladder and bowel are decompressed.

Useful in patients who are haemodynamically abnormal with blunt abdominal trauma, or multiple trajectory penetrating trauma

Question 4

How might the results of DPL affect decision to operate?

Answer 4

More than 10cc of blood on initial aspiration requires laparotomy.
Aspiration of gastrointestinal contents requires laparotomy.

Question 5

Identify some contrast studies used in the diagnosis of specific suspected injuries.

Answer 5

Urethography (?urethral injury)
Cystography (?bladder rupture)
IV pyelogram (?urinary system injuries)
GI contrast studies

Question 6

Indications for laparotomy

Answer 6

Blunt abdo trauma with hypotension with evidence of intraperitoneal bleeding (e.g positive FAST)

Hypotension with abdomianl wound

Gunshot wounds

Evisceration

Penetrating trauma that causes stomach, rectum or GU bleeding

Free air

Positive DPL

Question 7

Radiographical findings associated with diaphragmatic rupture

Answer 7

Elevation or blurring of affected hemidiaphragm
Abnormal gas shadow obsucring the hemidiagphragm
Gastric tube positioned in the chest
Haemothorax