Abdominal Trauma Flashcards
What does the team leader do?
Assigns roles, supervises, but not directly involved in the assessment itself
In the ATLS classification of shock, what’s the class 1 parameter of blood loss?
Less than 15%
In the ATLS classification of shock, what’s the class 2 parameter of blood loss?
15-30%
In the ATLS classification of shock, what’s the class 3 parameter of blood loss?
31-40%
In the ATLS classification of shock, what’s the class 4 parameter of blood loss?
More than 40%
Tranexamic acid is given in the ambulance within 3 hours of injury, when are the two doses given
Dose 1 over 10 mins, Dose 2 over 8 hours. First dose is given in the field
What is the preferred IO access site in adults?
The Proximal Humerus due to less pain and better circulation time
What is a DPL (Diagnostic peritoneal lavage)
Determines need for a laparotomy
When is a DPL positive
> 10ml frank blood, bacteria, high WBCS and Amylase
When do we decide to operate for Liver Trauma?
When there is persistent hypertension no matter what
All patients undergoing laparotomy for trauma should be explored through an incision where and why?
Midline incision, as it gives easy access to other organs in case of multi organ damage
How do we manage liver injuries of grades 1-2?
Sutures, tropical agents, electrocautery.
What is Electrocautery?
Using heat to destroy abnormal tissue
How are Grade 3 Liver injuries treated?
Major Intraparenchymal injuries with active bleeding are best managed by Finger Fracturing the hepatic parenchyma.
How are Grade 4 liver injuries treated?
Extensive intra-parenchymal injuries with major blood loss require ‘Occlusion of the portal trial to control hemorrhage”
Advanced techniques of liver injury repair are performed with what already in place
Pringle maneuver. Helps reduce blood loss during such ops
What is the most commonly injured organ from blunt trauma?
The spleen
What signs are suspicious on physical exam of spleen injury
Left upper quadrant bruising, mass, abrasion, left lower ribs fracture, and Kehr’s sign.
What is Kehr’s sign?
Shoulder tip pain
Operative treatment for spleen injury?
Splenectomy or splenorraphy
What’s the commonest injury in the urinary system?
Renal trauma
Physical signs of renal trauma
Flank abrasion, vertebral transverse process fracture, rib fracture
Renal trauma specific investigations
Intravenous urography and CT (IVU)
Renal trauma management of minor injuries?
Percutaneous drainage and antibiotics
Renal trauma management of severe injuries?
Partial or total nephrectomy
In abdominal penetrating trauma, what do we do for hemodynamically unstable patients?
Laparotomy
What does the CT show for bowel injury in penetrating trauma?
Thickening and contrast leak
What does the CT show for a peritoneal violation in penetrating abdominal injury?
Free air/fluid
What is the primary repair advantages?
Less hospital stay, less disability, less morbidity of the colostomy closure
When would we do a primary colon repair?
Hemodynamically unstable or peritonitis
How do we diagnose abdominal compartment syndrome?
Oliguria and increasing CVP
What is abdominal compartment syndrome?
When the abdomen is subject to increased pressure
Abdominal compartment treatment?
Laparostomy
