Abdominal Trauma • Blunt Trauma Flashcards
mechanisms:
blunt: usually causes solid organ injury (spleen = most common, liver = 2nd)
■ penetrating: usually causes hollow organ injury or liver injury (most common)
Seatbelt Injuries May Cause
- Retroperitoneal duodenal trauma
- Intraperitoneal bowel transection
- Mesenteric injury
- L-spine injury
Indications for Foley in
Abdominal Trauma
Foley catheter: unconscious or patient
with multiple injuries who cannot void
spontaneously or is unconscious
Indications for NG Tube in Abdominal Trauma
NG tube: used to decompress the stomach and proximal small bowel. Contraindicated
if suspected facial or basal skull fractures
BLUNT TRAUMA
results in two types of hemorrhage:______ and _____
intra-abdominal and retroperitoneal
adopt high clinical suspicion of bleeding in______
multi-system trauma
systenic Physical Exam in Abdominal Trauma
• often unreliable in multi-system trauma, wide spectrum of presentations
■ slow blood loss not immediately apparent
■ tachycardia, tachypnea, oliguria, febrile, hypotension
■ other injuries may mask symptoms
■ serial examinations are required
Abdominal Physical Exam in Trauma
inspect: contusions, abrasions, seat-belt sign, distention
■ auscultate: bruits, bowel sounds
■ palpate: tenderness, rebound tenderness, rigidity, guarding
■ DRE: rectal tone, blood, bone fragments, prostate location
■ placement of NG, Foley catheter should be considered part of the abdominal exam
• other systems to assess during Abdominal Trauma
cardiovascular, respiratory (possibility of diaphragm rupture), genitourinary, pelvis, back/neurological
Abdominal Trauma
Investigations
• labs: CBC, electrolytes, coagulation, cross and type, glucose, Cr, CK, lipase, amylase, liver enzymes, ABG, blood EtOH, β-hCG, U/A, toxicology screen
X-Ray Strengths
Chest (looking for free air under diaphragm,
diaphragmatic hernia, air-fluid levels), pelvis, cervical,
thoracic, lumbar spines
X-Ray Limitations
Soft tissue not well visualized
CT Scan Strengths
Most specific test
CT Scan Limitations
Radiation exposure 20x more than x-ray
Cannot use if hemodynamic instability
Diagnostic Peritoneal
Lavage (rarely used) Strengths
Most sensitive test
Tests for intra-peritoneal bleed
Diagnostic Peritoneal
Lavage (rarely used) Limitations
Cannot test for retroperitoneal bleed or
diaphragmatic rupture
Cannot distinguish lethal from trivial bleed
Results can take up to 1 h
Ultrasound: FAST Strengths
Identifies presence/absence of free fluid in peritoneal
cavity
RAPID exam: less than 5 min
Can also examine pericardium and pleural cavities
Ultrasound: FAST Limitations
NOT used to identify specific organ
injuries
If patient has ascites, FAST will be falsely
positive
Criteria for Positive Lavage
- > 10 cc gross blood
- Bile, bacteria, foreign material
- RBC count >100,000 x 106/L
- WBC >500 x 106/L,
- Amylase >175 IU
• imaging must be done if
■ equivocal abdominal examination, altered sensorium, or distracting injuries (e.g. head trauma,
spinal cord injury resulting in abdominal anesthesia)
■ unexplained shock/hypotension
■ patients have multiple traumas and must undergo general anesthesia for orthopedic, neurosurgical,
or other injuries
■ fractures of lower ribs, pelvis, spine
■ positive FAST
Management, general
ABCs, uid resuscitation, and stabilization
Management surgical
watchful waiting vs. laparotomy
Laparotomy is Mandatory if Penetrating
Trauma and:
• Shock • Peritonitis • Evisceration • Free air in abdomen • Blood in NG tube, Foley catheter, or on DRE
• solid organ injuries Management
: decision based on hemodynamic stability, not the specific injuries
• hemodynamically unstable or persistently high transfusion requirements:
laparotomy
• hollow organ injuries:
laparotomy
even if low suspicion of injury you should
admit and observe for 24 h
