Abdominal and spinal trauma Flashcards
What are the 2 main types of abdominal trauma
blunt and penetrating
Give examples of blunt abdominal trauma
Bruising/contusions, swelling/oedema of all organs
Small lacerations to the spleen and liver from the internal aspect of the ribs
Rupture of the spleen, gastrointestinal tract or bladder
Orthopaedic e.g. hip fractures
Give examples of penetrating abdominal traumas
Direct injury of an abdominal organ
Direct injury of major vessels
External contamination of the abdomen
What is the best method for diagnosing abdominal trauma?
POCUS
What should you do when you see free fluid in abdominal trauma?
Free fluid -> Abdominocentesis - Urine vs Blood.
How can you tell if free fluid in abdominal trauma is blood?
Centrifuge and measure PCV
Compare to peripheral PCV
Should be similar in acute bleeding
Peripheral TP may also be low supporting bleeding
How can you tell if free fluid in abdominal trauma is urine?
Centrifuge to remove red blood cells
Biochemistry on the supernatant
Compare to biochemistry on peripheral blood
- Creatinine >2x blood value (all species)
- Potassium >1.4x blood (dogs) >1.9x blood (cats)
Describe the treatment of haemoabdomen - blunt trauma
Usually non-surgical
Conservative management
- fluid therapy to support perfusion (large animals may need hypertonic saline - can increase bleeding)
- Blood products if necessary
- Abdominal wrap (not great treatment, inhibit ability to scan, pressure gradient inside abdomen to prevent bleeding - used when owner cannot afford transfusion)
- Tranexamic acid
What is tranexamic acid?
anti-fibrinolytic, helps to stabilise clot formation
be careful - clots formed can migrate and block organ perfusion e.g., lungs
Always use in greyhounds - have a hyperfibrinolytic disorder and post-op bleeding
What is the treatment for haemoabdomen - penetrating trauma
Surgical
- initial stabilisation with fluid therapy +/- blood products
- restore perfusion (use BP and lactate as primary measures)
- be prepared for complicated anaesthesia - myocardial hypoxia may have occured => cardiac arryhthmias (lidocaine)
- Exlap
- if source of bleeding is too severe/wide to stop, pack with swabs and close, re-operate 24-48hrs (remember to count swabs in and out)
- consider harvesting blood for ‘autotransfusion’
How is pneumoperitoneum identified and treated?
Free gas in abdomen on imaging indicates damage to GIT
Radiography more sensitive
Stabilise
Antibiotic cover
Exlap to identify damaged GIT and surgical repair
What is the life threatening problem with uroabdomen?
Hyperkalaemia:
- prevents repolarisation
- slowed cardiac potential
- severe bradycardia => atrial standstill
- death
What is the treatment for uroabdomen?
Surgical
Treat hyperkalaemia:
- Glucose and insulin drive potassium into cells
- Alkalinising fluid therapy (hartmann’s)
Drain abdomen and lavage with saline
Place urinary catheter - urine will drain from here even if bladder is perforated - provides time to look for damage and fix
If no leak from bladder - may need IV ureterography to assess ureters for leaks
What signs indicate spinal trauma during treatment?
Lack of response to fluid therapy alone to improve blood pressure
Requirement of vasopressor therapy
Neurological deficits
What does spinal cord transection cause?
a loss of autonomic control and a loss of vascular tone - neurogenic (distributive) shock
How can spinal issues be diagnosed?
Radiographs (orthogonal views important) - be careful with spinal manipulation (sedation if patient still has movement)
Describe the signs of upper motor neurone and lower motor neurone localisation in spinal trauma?
UMN – normal to increased reflexes and normal to increased tone
LMN – Decreased to absent reflexes and decreased to absent tone
Describe the treatment of spinal trauma?
Always refer if possible
Computed tomography is preferred for absolute diagnosis
If referral is not an option - euthanasia most viable
If there are no lesions present on radiography (+ cost is concern) - may have spinal contusions/bruising which can solve with time:
- supportive care e.g., pain relief, nutritional support, physio
- keep owners realistic - still poor prognosis
Euthanasia in large animals most viable
