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EM 3 > abdominal trauma > Flashcards

abdominal trauma Flashcards

1
Q

what is the goal of evaluating abdominal trauma

A

find and treat hemorrhage to prevent shock

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2
Q
  • steering wheel, car door
  • deforms solid organ > rupture > hemorrhage > contents leak > peritonitis
A

direct blow (type of blunt trauma)

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3
Q
  • seatbelt
  • deceleration injury > differential movement of fixed and nonfixed parts
  • splenic or liver lacerations (solid viscus), bucket handle injuries (shallow viscus)
A

shearing injury (type of blunt trauma)

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4
Q

which 3 organs are most commonly injured in blunt trauma

A
  1. spleen
  2. liver
  3. small bowel
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5
Q

which 4 organs are often injured in lacerating penetrating trauma

A
  • small bowel
  • liver
  • colon
  • diaphragm
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6
Q

which penetrating taruma tends to have delayed presentation

A

more kinetic injury– high velocity gun shot (rifles), explosives

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7
Q

gray turners sign vs cullens sign

A

gray turners: ecchymosis of flank
cullens sign: ecchymosis of umbilicus
brusing can tip you off to retroperitoneal hemorrhage

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8
Q
  • ecchymosis or hematoma of scrotum or perineum
A

possible urethral injury– NO foley

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9
Q

what is this procedure? 3 findings that would make it positive?

  • catheter in belly; free aspiratoin of gross blood, GI contents + HD instability = laparotomy
  • if no free aspirate– lavage w/ warmed NS & send effluent to lab
A

diagnostic peritoneal lavage (DPL)
its positive if over 100K RBC/mm3 OR over 500 WBC or (+) bacteria on gram stain

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10
Q

main adjunct to the P.E is…

A

FAST exam– Focused Assessment Sonography in Trauma– identifies 200-250ml of intraperitoneal fluid

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11
Q

what are the 4 views of the FAST exam

A
  • cardiac
  • RUQ: hepatorenal interface (morrisons pouch), etc
  • LUQ: splenorenal interface, potential space btwn spleen & diaphram, etc
  • suprapubic: retrovesicular (males), pouch of douglass (females)
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12
Q

3 disadvantages to FAST exam

A
  • limited for solid parenchymal damage, retroperitoneum or diaphragmatic defects
  • cant tell blood from ascites
  • high false neg rate in detecting hemoperitoneum in presence of pelvic fracture
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13
Q

in the FAST algorithm, what do you do next?

  • unstable pt w/ POS FAST
  • stable pt w/ POS FAST
  • stable pt, low MOI, NEG FAST
A
  • unstable pt w/ POS FAST: OR
  • stable pt w/ POS FAST: abdominal CT
  • stable pt, low MOI, NEG FAST: observe, serial exams

CT is gold standard w/ IV contrast

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14
Q

5 indications for emergency laparotomy

A
  • peritonitis
  • free air under diaphragm
  • significant bleeding or surgical pathology on CT
  • hypotension w/ (+) FAST or penetrating wound
  • evisceration
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15
Q

a tearing type injury to small bowel and mesentary can result in ..

A

bucket handle injury

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16
Q

3 common sources of penetrating trauma

A

stab
gunshort
explosives

EM 3 (4 decks)

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