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ATLS > Abdomen & Pelvic trauma > Flashcards

Abdomen & Pelvic trauma Flashcards

1
Q

What is the superior boundary of the peritoneum?

A

Lower thorax

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2
Q

What are the components of the anterior abdomen?

A
  1. Costal margins superiorly
  2. Inguinal ligaments
  3. Symphysis pubis inferiorly
  4. Anterior axillary lines laterally
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3
Q

What are the boundaries of the thoracoabdomen?

A
  1. The area inferior to the nipple line anteriorly
  2. Infrascapular line posteriorly
  3. Superior to the costal margins
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4
Q

What are the boundaries of the flanks?

A
  1. Between the anterior and posterior axillary lines
  2. Extends from the 6th intercostal space to the iliac crest
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5
Q

Components of the restroperitoneal space?

A
  1. Abdominal aorta
  2. Inferior vena cava
  3. Duodenum
  4. Pancrease
  5. Kidneys
  6. Ureters
  7. Posterior aspect of the ascending colon
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6
Q

The retroperitoneal space is not sampled by what investigation?

A

DPL

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7
Q

Primary and secondary injuries associated with blunt trauma to the abdomen?

A
  1. Injury to solid organs with harmorrhage
  2. Bowel leak with peritonitis
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8
Q

Frequently injured organs with blunt trauma ?

A
  1. Spleen (40-55%)
  2. Liver (35-45%)
  3. Small bowel (5-10%)
  4. Retroperitoneal haematoma (15%)
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9
Q

Frequency of injury with penetrating injury ?

A
  1. Liver (40%)
  2. Small bowel (30%)
  3. Diaphragm (20%)
  4. Colon (15%)
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10
Q

Classification of pelvic fractures ?

A
  1. AP compression (15-20%)
  2. Lateral compression (60-70%)
  3. Vertical shear (5-15%)
  4. Combined mechanism
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11
Q

Components of AP compression pelvic injury?

A
  1. External rotation of the hemipelvis
  2. Separation of the symphysis pubis
  3. Tearing of the posterior ligamentous complex
  4. Widening of the disrupted pelvic ring
  5. Tearing of the posterior venous plexus & branches of the internal iliac artery
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12
Q

Components of lateral compression pelvic injury?

A
  1. Hemipelvis rotates internally
  2. Pelvic volume is reduced
  3. Tension on the pelvic vascular structures is reduced
  4. Potential injury to bladder and urethra
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13
Q

Injury resulting from vertical displacement of the sacroiliac joint ?

A
  1. Disruption of iliac vasculature
  2. Severe haemorrhage
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14
Q

Components of vertical shearing pelvic injury?

A
  1. Disrupts the sacrospinous & sacrotuberous ligaments
  2. Major pelvic instability
  3. Occurs in falls > 12 feet
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15
Q

Mortality of patients with all types of pelvic fracture ?

A

5-30%

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16
Q

Mortality in patients with closed pelvic fracture and hypotension?

A

10-42%

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17
Q

Mortality in patients with open pelvic fracture ?

A

50%

18
Q

Boundaries of the anterior abdomen?

A
  • Superior - Costal margins
  • Inferior - Inguinal ligaments & symphysis pubis
  • Lateral - Anterior axillary line
19
Q

Organs at risk of injury in the anterior abdomen?

A

All solid and hollow viscera

20
Q

Boundaries of the thoraco-abdomen?

A
  • Superior - Nipple line anteriorly & infrascapular posteriorly
  • Inferior - Costal margins
21
Q

Organs at risk of injury in the thoraco-abdomen?

A
  • Liver
  • Spleen
  • Diaphragm
  • Stomach
22
Q

Boundaries of the flanks?

A

Superior - 6th intercostal space
Inferior - Iliac crest
- Anterior - Anterior axillary line
- Posterior - Posterior axillary line

23
Q

Organs at risk of injury in the flanks?

A
  • Hollow viscera
  • Liver
  • Spleen
  • Kidney
  • Diaphragm
  • Stomach
24
Q

Boundaries of the back?

A

Superior - Tip of scapula
- Inferior - Iliac crest
- Lateral - Posterior axillary lines
- Posterior thoraco-abdomen & restroperitoneal space

25
Q

Organs at risk of injury in the back?

A
  • Aorta
  • Vena cava
  • Duodenum
  • Pancreas
  • Kidney
  • Ureters
  • Retro-peritoneal portion of the ascending & descending colon
26
Q

Boundaries of the pelvic cavity?

A
  • Pelvic bones
  • Lower portion of the retro-peritoneal and intraperitoneal space
27
Q

Organs at risk of injury in the pelvic cavity?

A
  • Rectum
  • Bladder
  • Iliac vessels
  • Internal reproductive organs
28
Q

What are examples of blunt trauma?

A
  • Direct blow
  • Shearing force
  • Deceleration - Liver & spleen
29
Q

Injury associated with restraint devices - Lap seat belt?

A
  • Bowel mesentery
  • Rupture small bowel or colon
  • Iliac artery or aortic thrombosis
  • Lumbar vertebral fracture (Chance)
  • Pancreatic & duodenal injury
30
Q

Injury associated with restraint devices - Shoulder harness?

A
  • Upper abdomen visceral rupture
  • Intimal tear or thrombosis - Carotid, subclavian & vertebral arteries
  • C-spine fracture or dislocation
  • Rib fracture
  • Pulmonary contusion
31
Q

Injury associated with restraint devices - Airbag?

A
  • Face & eye abrasion
  • Cardiac injury
  • Spine fracture
32
Q

Injury to the epigastrium raises suspicion of injury to what structures?

A
  • Small bowel
  • Duodenum
  • Pancreas
33
Q

Signs of pelvic fracture ?

A
  • Evidence of urethral rupture
  • Limb length discrepancies
  • Rotational deformity of leg
34
Q

Initial management of pelvic fracture?

A
  • Haemorrhage control
  • Fluid resuscitation
  • Early transfer to trauma centre
35
Q

Haemorrhage control of pelvic fracture?

A
  • Stabilization with binder
  • Internal rotation of limb - Reduce volume
36
Q

Pertinent history regarding MVC?

A
  • Vehicle speed
  • Collision type
  • Intrusion into passenger compartment
  • Ejection
  • Restraint type
  • Airbag deployment
  • Patient position
  • Status of other passengers
37
Q

Pertinent history regarding falls?

A
  • Height of fall
38
Q

Pertinent history regarding penetrating injury?

A
  • Time of injury
  • Type of weapon
  • Distant from assailant
  • Number of wounds
  • Estimated blood loss
39
Q

Pertinent history regarding explosive injuries?

A
  • Distance from explosion
  • Open or enclosed space
  • Secondary impact - Thrown or fall
  • Secondary projectiles
40
Q

Haemorrhagic control of pelvic fracture ?

A

Emergent:
- Pelvic binders
- Internal rotation of lower limb

Definitive:
- Angiographic embolization
- Operative control

41
Q

Relative contraindications of DPL?

A
  • Previous abdominal operation
  • Advanced Cirrhosis
  • Coagulopathy
  • Morbid obesity

ATLS (10 decks)

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