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atls > Abdominal and Pelvic trauma > Flashcards

Abdominal and Pelvic trauma Flashcards

1
Q

Clinical regions of the abdomen

A

Anterior abdomen
Thoracoabdomen
Flank
Back
Pelvic cavity

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2
Q

Boundaries of anterior abdomen

A

Superior - costal margins

Inferior - inguinal ligaments and pubic symphysis

Lateral - anterior axillary lines

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3
Q

Organs at risk in the anterior abdomen

A

Most solid and hollow viscera

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4
Q

Boundaries of the thoracoabdomen

A

Superior - nipple line anteriorly, infra-scapular line posteriorly

Inferior - costal margins

No lateral boundary as runs around entire circumference of torso

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5
Q

Organs at risk in the thoracoabdomen

A

Diaphragm
Liver
Spleen
Stomach

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6
Q

Boundaries of the flank

A

Superior - 6th intercostal space
Anterior - anterior axillary line
Posterior - posterior axillary line
Inferior - iliac crest

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7
Q

Organs at risk in the flank

A

Most hollow viscera
Diaphragm
Liver / spleen
Stomach

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8
Q

Boundaries of the back

A

Superior - tip of the scapulae
Lateral - posterior axillary lines
Inferior - iliac crests

Includes the posterior thoracoabdomen and retroperitoneal space

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9
Q

Organs at risk in the back

A

Aorta + Vena cava
Duodenum
Pancreas
Kidneys + Ureters
Retroperitoneal parts of ascending / descending colon

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10
Q

Boundaries of the pelvic cavity

A

Pelvic bones

Contains lower part of the retroperitoneal and intraperitoneal spaces

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11
Q

Organs at risk in the pelvic cavity

A

Rectum
Bladder
Iliac vessels
Internal reproductive organs (females)
Blood loss from bony pelvis

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12
Q

Forms of blunt trauma

A

Direct blow
Shearing forces
Deceleration

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13
Q

Direct blow consequences

A

Can cause:
- Compression and crushing injuries
- Rupture
- Secondary haemorrhage
- Contamination by visceral contents

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14
Q

Shearing forces mechanism

A

Can result from use of restraints and cause crushing injury

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15
Q

Deceleration forces mechanism

A

Differential movement of fixed and mobile parts of the body

Can cause tears at fixed points

(eg. liver and spleen which are mobile organs tethered at fixed points by supporting ligaments)

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16
Q

Injuries associated with lap seat belt restraint

A

Tear / avulsion of bowel mesentery
Rupture of bowel
Iliac artery / aortic thrombosis
Lumbar vertebra “Chance” fracture
Pancreatic / duodenal injury

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17
Q

Lumbar vertebral chance fracture

A

Caused by flexion-distraction injury

Unstable

Horizontal fracture through spinous process, pedicles and vertebral body

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18
Q

Injuries associated with shoulder harness restraints

A

Upper abdo viscera rupture

Tear / thrombosis of carotid, subclavian or vertebral arteries

C spine fracture / dislocation

Rib fracture

Pulmonary contusion

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19
Q

Injuries associated with air bag use

A

Face and eye abrasions

Cardiac injuries

Spine fractures

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20
Q

Mechanism of injury with low energy penetrating trauma (inc low energy gunshot wounds)

A

Tissue damage from lacerating and tearing

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21
Q

Mechanism of injury with high energy penetrating trauma (inc high energy gunshot wounds)

A

Additional tissue damage due to trajectory, cavitation effect and bullet fragmentation

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22
Q

Mechanisms of injury associated with explosions

A

Penetrating fragment wounds

Blunt injuries from being thrown

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23
Q

Physical examination findings which suggest pelvic fractures

A

Ruptured urethra (scrotal haematoma or blood at urethral meatus

Discrepancy of limb length

Rotational leg deformity with no clear fracture

24
Q

How frequently should pelvis be assessed for mechanical stability

A

Not at all as may disrupt existing blood clot

Assume instability of pelvic ring where pelvic fracture suspected

Use pelvic binder

25
Q

Useful information in patient Hx for motor vehicle crash

A

Speed
Collision type
Intrusion into passenger compartment
Ejection
Restraint type
Air bag deployment
Patient position
Status of other passengers

26
Q

Useful information in patient Hx for falls

A

Height of fall

27
Q

Useful information in patient Hx for penetrating trauma

A

Time of injury
Type of weapon
Distance from assailant
Number of stab / gunshot wounds
Amount of external blood at scene

28
Q

Useful information in patient Hx for explosion

A

Distance from explosion
Enclosed or open space
Secondary impact (eg thrown / fall)
Secondary projectiles

29
Q

Important evaluation in pregnancy with abdo trauma

A

Estimate foetal age

30
Q

Benefit from using a pelvic binder

A

Reduces pelvic radius and therefore reduces potential space available for blood loss

31
Q

Methods of haemorrhage control from pelvic fracture in ED

A

Stabilisation with:
- Pelvic binder (at level of greater trochanters)
- Sheet
- Internal rotation of lower limbs

32
Q

Methods of definitive haemorrhage control in pelvic fractures

A

Surgery

Angiographic embolization

33
Q

Contraindication to bladder catheterisation

A

Perineal haematoma or blood at urethral meatus before definitive assessment for urethral injury

34
Q

When to perform rectal, vagina or gluteal examination

A

Bony fragments from pelvic fracture or penetrating injury suspected

35
Q

Goal of gastric tube placement in trauma patients

A

Relieve gastric dilatation and decompress stomach

36
Q

Blood in gastric contents of gastric tube

A

Suggests oesophageal or upper GI injury

37
Q

Contraindication to NG tube

A

Facial fractures
Basal skull fractures

38
Q

Options when NG tube contraindication

A

Insert gastric tube through mouth

(Orogastric tube rather than Nasogastric tube)

39
Q

Goals of urinary catheterisation

A

Identify bleeding
Monitor UO
Decompress bladder (wait until after FAST scan if can)

40
Q

Which patients require retrograde urethrogram

A

Cannot void bladder
Require pelvic binder
Blood at urethral meatus
Scrotal haematoma
Perineal ecchymosis

41
Q

Most common cause of free fluid in abdomen with abdominal organs intact on CT

A

Mesenteric tears

Bowel rupture

42
Q

Seat-belt sign

A

Have high suspicion of bowel injury

43
Q

XR to perform in Haemodynamically Abnormal patient with penetrating abdominal trauma

A

No screening X rays

44
Q

XR to perform in Haemodynamically Normal patient with penetrating abdominal trauma - wound above umbilicus or suspected thoracoabdominal injury

A

Erect CXR

45
Q

XR to perform in Haemodynamically Normal patient with penetrating abdominal trauma - with gunshot wound(s)

A

Supine abdo XR

46
Q

Advantages of FAST scan

A

Early operative determination
Non-invasive
Repeatable
Rapid

47
Q

Disadvantages of FAST scan

A

Operator dependant
Bowel gas / body habitus can distort images
Can miss diaphragm or pancreas injury
Does not fully assess retroperitoneal structures

48
Q

Goal of diagnostic peritoneal lavage (DPL)

A

Rapidly identify intraperitoneal bleeding and need for operation

49
Q

When is DPL most useful

A

Haemodynamically Abnormal patients with:
- Blunt abdo trauma
- Penetrating abdo trauma without indication for immediate laparotomy

Can be performed in resuscitation area

50
Q

Disadvantages with DPL

A

Invasive
Requires surgical expertise

51
Q

Relative contraindications to DPL

A

Previous abdo surgery
Morbid obesity
Advanced cirrhosis
Pre-existing coagulopathy

52
Q

Indications for immediate emergency laparotomy in patients with penetrating abdominal wounds

A

Any haemodynamically abnormal patient

Gunshot wound with transperitoneal trajectory

Peritonitis

Signs of peritoneal penetration (eg. evisceration)

Free / extra-luminal air on imaging

Retained stabbing implement

Positive FAST / DPL / CT

Blood per gastric, rectal or genitourinary tract

53
Q

Indications for immediate emergency laparotomy in patients with blunt abdominal trauma

A

Haemodynamically abnormal with positive FAST / DPL or suspected abdo injury

Positive CT scan and haemodynamic status not improving

Extra-luminal air on imaging

Evidence of diaphragm rupture

Evidence of intraperitoneal bladder rupture

Peritonitis

54
Q

When to suspect blunt hollow viscus injuries

A

Sudden deceleration mechanism

Seat-belt sign

Lumbar chance fracture

Abdo pain / tenderness

55
Q

When to suspect blunt duodenal injuries

A

Unrestrained driver in front impact crash

Direct abdominal blow

Blood in gastric aspirate

Retroperitoneal air on imaging

56
Q

Mechanism for blunt pancreatic injuries

A

Compression of pancreas against vertebral column

From direct epigastric blow

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