Abdominal and Pelvic trauma Flashcards
Lap seat belt injuries
Compression/ Hyperflexion
Tear or avulsion of mesentery - bucket handle
Rupture of bowel
Iliac artery or aortic thrombosis
Lumbar # - Chance
Pancreatic or duodenal injury
Shoulder harness injury associated
Compression/Sliding under seat belt
Upper abdominal visceral rupture
Intimal tear/thrombosis of subclavian/carotid/verterbral arteries
Cervical spine #/dislocation
Rib #
Pulmonary contusion
Explosion injury
Overpressure injury to eardrum, lungs and bowel causing hypoxia and ischaemia
Primary blunt injury from blast force
Secondary injury from penetrating fragments/projectiles
Tertiary brain injury e.g contrecoup
Indications for emegency laparotomy in penetrating injuries
Haemodynamically unstable and nonresponsive
Gunshot wound with transperiotoneal trajectory
Signs of peritoneal irritation
Signs of peritoneal penetration (evisceration)
Free air on imaging e.g. CXR
PV/PU/PR bleeding
Penetrating wound to thoracoabdomen, suspecting diaphragmatic injury
Findings suggestive of a pelvic fracture
Scrotal haematoma
Urethral meatus bleeding
Discrepancy in limb length
Rotational deformity of leg without obvious fracture
Once stabilised DO NOT move pelvis, may dislodge a clot and cause further haemorrhage
Types of pelvic fracture
Lateral compression
Vertical shear (onesided)
Anterior-posterior compression
Examination for abdo pelvic trauma
Expose and inspect chest, flank, abdo, back, glutes perineum and perianal area
PR
PV
Urethral examination
Pelvic fracture fragments or blunt trauma can cause PU/PV/PR bleeding
Indication for retrograde urethrogram
Pelvic binder
Blood at meatus
Scrotal haematoma
Perineal ecchymosis
Voiding difficulty
XR for haemodynamically normal with penetrating wound above umbilicus or suspected thoracoabdominal injury
Upright CXR
XR for haemodynamically normal with gunshot wound
Supine AXR
When to suspect blunt duodenal injury
Bloody NGT aspiration, retroperitoneal air on CT
When to suspect hollow viscus injury
Seat belt sign
Chance fracture
Sudden deceleration injury
Monitoring for signs of haemorrhage/peritonitis
HR
BP
Acidosis
Response to IVI
Peritonitis
Hb drop
