abdo and pelvic trauma Flashcards
3 types of abdo trauma that might need to manage
- low BP - determine cause
- low BP and abdo bleed - laparotomy
- norm BP and abdo bleed - further investigationvs
5 investigations for abdo trauma
clinical exam useless
- U/S
- CT
- laparoscopy
- angiography
- wound exploration
what is U/S good for and 4 locations
good for blood, not organ injury
- RUQ
- LUQ
- bladder
- pericardium
indications for US
- low BP
- need at least 400CC to be pos
adv. and dis of US
adv. - non-invasive, portable, high spec
dis - EARLY, hard in obese
when to use CT
- only in stable Pt
- IV contrast
- good for Dx of solid organ probs
- misses hollow organs
- misses diaphram
3 indications for laparotomy
- hemodynaimc instability
- peritonitis
- obvious diaphragmatic injury
when can one manage non-operatively
- solid organ injuries
- hemo stability
3 keys to abdo surgery
- prevent/minimize
- hypothermia
- coagulopathy
- acidosis - deal with only life threatening issues
- tamponade bleeding (packs) - resus. in ICU
what is problem with tamponade
abdo compartment syndrome
what is problematic intra-abdo pressure
> 12
what are effects of high IAP
CV- less blood return
Resp - less somliance, low FRC
renal - low/no urine
neuro - increased ICP
what is IAH vs. ACS
IAH is the lower end of a continuum
2 ways to measure IAP
- direct - cath. in cavity
2 indirect - bladder
treat of ACS
open abdo and put temp cover on it
why are pelvic fractures bad
- can bleed a lot
- high morb
3 parts of pelvic diagnosis
- clincal exam - mech instability
- plain x-rays
- CT
where are most pelvic bleeds from
- venous and bones more
- ## posterior aspect of pelvis
3 ways to stop pelvic bleeds
- stabilize pelvis
- bind or sheet - surgery
- angio and cuatery
2 types of packing done in pelvic fractures
- extra-peritoneal
- midline incision below umbilicus - retro-peritoneal
- put in behind retracted bladder
whan to do angio
- contrast blush on CT
- # and low BP despite other measures
2 definitive fracture treatments
- external fixation
2. open reduction and internal fixation
steps to PT with pelvic # and low BP
- rule out additional sources of hypotension
- pelvic binder or sheet
- if FAST +
- OR or angio - if FAST -
- binder
4 if BP improves
- CT and then ICU
