Abdominal and Pelvic trauma Flashcards
What is the highest surface landmark where an injury could lead to abdominal injury
Diaphragm rises to the level of 4th intercostal space
Any injury below the nipple line could injure abdominal viscera
Most common abdominal organs injured after a blunt injury (eg a deceleration injury)
Spleen 40%
Liver 35%
Small bowel 5%
Most common organ injured from stab wounds
Liver 40%
Small bowel 30%
Colon 15%
Most common organ injured from a gunshot
Small bowel 50%
Colon 40%
Liver
Abdominal vasculature
Correct position of pelvic binder
Centred over the trochanter
(not over the iliac crest)
Examination of a potentially unstable pelvis
If evidence of ruptured urethra, a discrepancy of limb length, a rotational deformity of limb present, do not manipulate the pelvis as may dislodge a clot
Instead do gentle palpation
Catheterisation in presence of a possible urethral injury
Dont do a urethral catheter
Do a suprapubic
Indications for a retrograde urethrogram
Pt unable to void
Pelvic binder in situ
Blood at meatus
Scrotal haematoma
Perineal bruising
Should a CT scan be done if already indicated to transfer to a tertiary centre
No don’t delay transfer
Diagnostic peritoneal lavage (DPL) indications
Abnormal haemodynamics in abdominal trauma without indication for immediate laparotomy
Problems with DPL
Invasive
Requires gastric and urinary decompression to avoid injury but interferes with subsequent FAST or CT
Now mostly replaced by FAST scan
What findings from DPL indicates for an urgent laparotomy
Aspiration of GI content
Aspiration of 10 ml of blood in haemodynamically abnormal patient
FAST scan components
Pericardial sac
Hepatorenal fossa
Splenorenal fossa
Pelvis or pouch of Douglas
Limitations of FAST scan
Bowel gas or subcutaneous air distort images
Does not completely assess retroperitoneal structures
Doesn’t show extra-luminal air
Obesity
Indications for laparoscopy for diaphragmatic injury
In haemodynamically stable patients, to diagnose:
- diaphragmatic injury
- peritoneal perforation
What type of CT to assess for urinary system injuries
Contrast CT (non-contrast for kidney stones)
Indications for urgent laparotomy
Haemodynamically unstable
Gunshot with a transperitoneal trajectory
Signs of peritoneal irritation
Signs of peritoneal perforation (extra-luminal air)
Bleeding from stomach, rectum or genito-urinary tract following penetrating trauma
Urethral disruption injuries classification
Above urogenital diaphragm (posterior)
Below urogenital diaphragm (anterior)
Cause of posterior urethral disruption
multisystem injuries and pelvic fractures
Causes of anterior urethral injury
Isolated injury from a straddle impact
Chance fracture
Lumbar distraction fracture
Are commonly associated with intestinal injuries
Fracture all the way through the spinous process to vertebral body
Mechanism of injury causing chance fractures
compression- distraction
Pelvic fracture types
Lateral compression 60-70%
Anterior posterior (AP) compression 15-20%
Vertical shear 5-15%
Pathophysiology of AP compression pelvic fracture
Associated with motorcycle or head-on motor vehicle crash
The disruption of the pelvic ring widens, tearing the posterior venous plexus and branches of internal iliac artery
