Abdominal and genitourinary Trauma Flashcards
What is Kehr’s sign?
severe pain in the left shoulder that occurs in some patients with a ruptured spleen
What is Cullen’s sign?
periumbilical bruising, may indicate intraperitoneal bleeding
What is Grey Turners sign?
bruising of the loins in acute hemorrhagic pancreatitis, also called Turner’s sign, may indicate retroperitoneal bleeding
Consult a ____ ____ for any patient suspected of having an abdominal or genitourinary injury. If a trauma surgeon is unavailable, what should you do?
trauma surgeon
transfer the patient to another facility.
Before inserting a urinary catheter into a male patient with blunt abdominal trauma, a ____ exam should be performed in order to confirm the position of the ____, look for ____ ____, and check the ____ ____
rectal
prostate
rectal tone
sphincter tone
what is FAST sonography?
Focused Assessment with Sonography in Trauma
The Focused Assessment with Sonography in Trauma (FAST) is an ultrasound protocol developed to assess for hemoperitoneum and hemopericardium. Numerous studies have demonstrated sensitivities between 85% to 96% and specificities exceeding 98%
What is the most commonly injured organ in the abdomen due to its location?
spleen
What are the S/S that indicate an injured spleen?
LUQ pain and tenderness, Kehr’s sign, abdominal muscle rigidity, involuntary guarding, rebound tenderness, signs of hemorrhagic or hypovolemic shock
How do you treat an injured spleen?
Might not require surgery, just bedrest and possible transfusion
Spleen injuries are described by a grading system. How may grades are there?
5
Describe a Grade 1 spleen injury.
nonbleeding capsular tear is less than 1 cm deep
Describe a Grade 2 spleen injury.
subcapsular hematoma covers 10% to 50% of the surface area and does not expand. Intraparenchymal hematoma is less than 2 cm wide
Laceration - capsular tear is accompanied by active bleeding. Intraparenchymal injury is 1 to 3 cm deep.
Describe a Grade 3 spleen injury.
subcapsular hematoma involves more than 50% of the surface area or is expanding. Intraparenchymal hematoma is 5 cm or larger or expanding. Ruptured subcapsular hematoma is accompanied by active bleeding.
Laceration is more than 3 cm deep or involves intracellular vessels.
Describe a Grade 4 spleen injury.
ruptured intraparenchymal hematoma is accompanied by active bleeding
Laceration is segmental or involves hilar vessels and devascularization of more than 25% of the spleen
Describe a Grade 5 spleen injury.
spleen is shattered. Laceration causes hilar vascular injury. Spleen is devascularized.
At any given time, __% of the circulating blood is in the liver
30%
Overall mortality of liver injury is __ %
12.5 %
Expect to see liver injuries when the patient receives a direct blow to this area.
the RUQ from the 6th rib to the central abdomen.
S/S of liver injury include what? (7)
Pain in RUQ or referred pain to the right shoulder
Abdominal muscle rigidity, spasm, or involuntary guarding
Rebound tenderness
Hypoactive bowel sounds
Cullen’s sign
Dullness with percussion
Elevated liver function tests.
When the liver sustains major damage, ____ ____ almost always occurs, The trauma team should consider acute hepatic injury if this occurs.
hemodynamic instability
the patient remains hypotensive despite aggressive intravenous fluid resuscitation.
More than __% of patients with liver injury are successfully treated with nonoperative management.
85%
Liver injury has a grading system that consists of __ grades.
6
Describe a Grade 1 liver injury.
non expanding subcapsular hematoma involves less than 10% of the liver’s surface
Laceration - nonbleeding capsular tear is less than 1 cm deep
Describe a Grade 2 liver injury.
non expanding subcapsular hematoma covers 10 to 50% of the surface area and is less than 2 cm deep.
Laceration penetrates less than 3 cm into the parenchyma and is less than 10 cm long
