Abdominal Trauma Flashcards
How does blunt abdominal trauma present
Blunt abdominal trauma injuries are notoriously harder to detect and patients often present with generalized abdominal tenderness. Nausea and vomiting can sometimes occur.
How does penetrating abdominal trauma present?
Penetrating injuries are easier to detect. Hemodynamically stable patient often complain of abdominal tenderness, and their exams can reveal peritoneal signs. Of the penetrating injuries GSW are notoriously deceptive for reasons mentioned previously.
What are common injuries in blunt abdominal trauma?
With blunt trauma splenic rupture is the most common injury followed by liver lacerations. Bladder rupture can also be encountered. Intestinal injuries although less common can definitely occur. Blunt abdominal trauma can also lead to diaphragmatic rupture especially on the left side. And pelvic fracture.
What are common injuries of penetrating abdominal trauma?
With GSWs small intestine and colonic injuries are most common whereas with SWs, liver injuries are predominant.
GSW most common
small bowel, colon, liver, vasculature
SV most common
Liver, small bowel, diaphragm, colon
What is standard of care imaging for bat?
The bedside sonogram has become standard of care when evaluating patients with BAT. Free fluid in Morrison’s pouch is pathognomonic for hemo-peritoneum, requiring emergent surgical intervention
When is a diagnostic peritoneal lavage positive? And if positive, what does this indicate?
A DPL is considered positive if there is aspiration of 10 mL of gross blood or gastrointestinal contents, or the presence >100,000 RBC/mm3, >500 WBC/mm3, or vegetable matter in the liter of saline infused.
Indicates need for laparotomy
What imaging is best for stable patients?
For stable patients the cornerstone of diagnosis is the CT Scan with IV contrast.
Initial treatment?
In patients with known abdominal trauma, antibiotics should be started in the ED, tetanus should be updated. Blood should be transfused as needed, keeping in mind principles of permissive hypotension.
What is permissive hypotension?
avoiding aggressive crystalloid resuscitation of trauma patients, in favor of blood product resuscitation to a specific defined Mean Arterial Pressure (MAP) of 65. The thought is that any increases in BP or excessive crystalloid administration further exacerbates the lethal trauma triad : coagulopathy, acidodis, and hypothermia which all eventually beget each other and cause the patient to spiral towards death
What liver lacerations require surgery?
Although simple grade I and II spleen and liver lacerations can often be managed with conservative management and blood transfusions, complicated lacerations grade IV and above often require surgical intervention.
Who are candidates for ED thoracotomies?
Although blunt thoraco-abdominal trauma patients are no longer candidates for ED thoracotomies, select penetrating thoraco-abdominal trauma patients are candidates for ED thoracotomies
