Abdominal Trauma Flashcards
Who?
Young men
Epidemic
Leading cause of death <50
18,000 deaths per year
When do deaths occur?
- immediate within minutes of injury
- within hours of arrival to hospital
- late days - weeks after injury
Golden Hour
Period of time following traumatic injury during which there is highest likelihood that prompt medical and surgical treatment will prevent death
What info do you give at handover?
ADMIST Age Time Mechanism Injuries Signs and symptoms Treatment
Haemorrhage
- if SBP<90 -> access femoral artery for REBOA - resus endovascular balloon occlusion of aorta
- CXR shows possible aortic injury?
- if yes = no REBOA
- if no = REBOA
Common abdominal trauma incidents
Deceleration injuries
Which organs are commonly injured?
Spleen - blunt trauma
Liver - stab wounds
Small bowel - gunshot wounds
Urethral tears
Blunt trauma
- no break in skin
- falls/sports/assaults/road traffic
- spleen>liver>s & l bowel
Penetrating trauma
- pierces skin
- stab, gunshot
- small bowel>stomach>pancreas
Crush trauma
- compression
- natural disaster/assault
- rhabdomyolysis, crush syndrome
Ix for blunt trauma when haemodynamically stable
FAST = focused assessment with sonography for trauma
or CT if tenderness/bruising
Ix for blunt trauma when haemodynamically unstable
- bleeding site identify and control
- 2 large bore IV lines for resus + catheter
- draw blood for crossmatch in case of transfusion
- radiography = rule out haemothorax/pelvic fracture
Ix for penetrating trauma
Laparotomy if peritonitis/haemodynamic instability
- local wound explore to see perforation
Bowel Injury
Penetrating>blunt Peritonitis Rigid abdomen and diffuse tenderness CXR = pneumoperitoneum CT = fluid, bowel wall thickening Open abdominal surgery
Liver Injury
RUQ Pain Right Lower limb fractures CT contrast = bleed, lacerations FBC = low Hb and Hct FAST Surgical if haemo unstable
Splenic Ijury
Blunt>penetrating LUQ Pain to left shoulder (Kehr's sign) Left lower rib fractures Hypovolaemia CT contast FBC FAST
Abdominal Compartment Syndrome
Intra-abdo pressure >200mmHg
Impaired organ perfusion
Due to too much fluid resus or massive blood transfusion
Presentation of compartment syndrome
Increased airways pressure
Low UO
Tense Aodmen
Management of compartment syndrome
Optimise fluid balance Correct body position Analgesia Neuromuscular blockade If fails = surgical abdo decompression
