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Emed 4 > ABD trauma > Flashcards

ABD trauma Flashcards

1
Q

MC injured ABD organs

A

Liver - overall

Spleen - sports related

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2
Q

MC MOI for blunt trauma is?

A

MCV

- then falls

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3
Q

Typical blunt trauma mechanism is

A

Hollow viscous rupture

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4
Q

W/ any penetrating injury of lower chest, pelvis, flank, or back assume it has?

A

Penetrated the ABD cavity until R/O?

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5
Q

What hematoma mimics intra-abdominal injury

A

Rectus abdominas hematomas from epigastric trauma/Abd wall vessel injury

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6
Q

Rectus abdominas hematomas May evolve into?

A

Painful palpable mass between rectus sheath inferior to umbilicus

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7
Q

S/S of solid organ injury is due to? S/S?

A

Blood loss

- increased pulse pressure

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8
Q

Referred pain into shoulders may indicate what type of ABD injury?

A

Splenic injuries - left arm

Liver injuries - right arm

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9
Q

What conditions may predispose a pt to splenic conditions?

A

Pregnancy and mononucleosis

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10
Q

Hollow viscous injuries produce S/S due to?

A

Blood loss and peritoneal contamination from GI

  • Gastric acid = chemical irritation
  • Bacterial GI flora - Delayed
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11
Q

Are Pancreatic injuries generally low M/M?

A

NO - high M/M

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12
Q

Pancreatic injury S/S?

A

No specific S/S - Use MOI for clues (ex- unrestrained driver who hits steering column/bicyclist against handle bar.

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13
Q

Duodenal injuries S/S?

A

Relatively asymptomatic
Duodenal hematoma expands- gastric outlet obstruct
- ABD pain, distention, vomiting
High Velocity - duodenal rupture

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14
Q

ABD Abscess/sepsis S/S?

A

Delayed presentation

  • fever
  • leukocytosis
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15
Q

Direct blow to epigastric may cause?

A

Diaphragm spasm - difficulty breathing

-cant relax and expand

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16
Q

Diaphragmatic Injuries MC occurs where?

A

Left side

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17
Q

Failure to Dx diaphragmatic rupture may lead to?

A

Herniation or strangulation of bowel through diaphragm defect

18
Q

Primary diagnostic study of ABD injuries?

A

FAST

19
Q

FAST greatest benefit is?

A

Rapid identification of free intraperitoneal fluid in HOTN pt w/ blunt ABD trauma and w/ serial images can estimate rate

20
Q

Average time to perform FAST exam of thoracic and abdominal cavaties?

A

=<4m

21
Q

View of Morrisons pouch w/ HOTN pt may reveal?

A

Massive hemoperitoneum

22
Q

One major advantage of FAST exam over Dx peritoneal lavage is?

A

FAST can also eval pericardial/pleural fluid and for PTX

23
Q

Main disadvantage of FAST over CT is?

A

Inability to ID source of free intraperitoneal fluid

-also cannot eval retroperitoneum as well as CT

24
Q

Other general disadvantages of FAST?

A

Skilled operator
Eval obese, Sub-Q air, excess bowel gas
Differ bleed from ascites

25
Q

What can FAST or CT eval for intravascular volume and mortality prediction?

A

IVC

26
Q

Is a positive DPL (dx peritoneal lavage) an absolute indication for exploratory laparotomy?

A

No

27
Q

What is gold standard of abdominal injury dx?

A

CT w/ contrast

28
Q

Major advantage of CT w/ contrast?

A

ID precise location, grade of injury, type of fluid and amount
+
Eval retroperitoneal injuries (duodenum/pancreas)

29
Q

CT imaging reqs a pt to be?

A

Hemodynamically stable

30
Q

TXT Gold standard for significant intra-abdominal injury?

A

Laparotomy

-complete eval of abdomen/retroperitoneal

31
Q

All pts w/ persistent HOTN, abdominal wall disruption or peritonitis in regards to trauma req?

A

Surgical exploration

32
Q

Absolute Indications - blunt

A 
Anterior ABD injury + HOTN
ABD wall disruption
Peritonitis
Free air under diaphragm on CXR
Positive FAST or DPL + unstable hemodynamically
CT - Dx injury req surgery
33
Q

Relative indications - blunt?

A

Positive FAST or DPL and stable hemodynamically
Solid visceral injury in stable pt
Hemoperitoneum on CT w/out clear source

34
Q

Absolute Indications - penetrating?

A 
Injury to ABD, back, flank
ABD TTP
GI Evisceration
High suspicion for transabdominal trajectory after gunshot
CT-Dx injury req surgery
35
Q

Relative indications - penetrating?

A

Positive local wound exploration after stab wound.

36
Q

Non-op management for blunt trauma is based on?

A

CT grading

37
Q

Pts w/ ABD trauma at in extremis may benefit from?

A

REBOA - Resuscitative endovascular balloon occlusion of the aorta.

38
Q

Fx of REBOA is to?

A

Quickly stop intra-abdominal hemorrhage by aortic occlusion while maintaing/increasing heart/lung perfusion.

39
Q

REBOA aorta zones

A

I- descencding thoracic aorta - between subclavian/celiac
II- between celiac and lowest renal artery
III- Lowest renal artery to Bifurcation

40
Q

Maximum time REBOA may stay in place?

A

60m

41
Q

D/C pts who develop fever, vomiting, increased pain, or symptoms suggestive of blood loss (dizzy/weak/fatigue) should?

A

Return promptly to ED - other msot pts are admitted

Emed 4 (10 decks)

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