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A1 > ATLS-Abdominal Trauma > Flashcards

ATLS-Abdominal Trauma Flashcards

1
Q

Penetrating injuries above and below what landmarks indicate the need to assess for intraperitoneal injury?

A

Below the nipple line, and above the perineum

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2
Q

What are the boundaries of the anterior abdomen?

A 
Superior = costal margins
Inferior = inguinal ligaments and pubis symphasis
Laterally = anterior axillary lines
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3
Q

What are the boundaries of the thoacoabdomen?

A 
Superior = Nipple line/infrascapular line
Inferior = costal margins
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4
Q

What diaphragm rises to what rib level during full expiration?

A

4th rib

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5
Q

What are the components of the SAD PUCKER mnemonic for the retroperitoneal organs?

A 
Supra Adrenal glands
Aorta
Duodenum
Pancreas
Ureters
Colon (ascending and descending)
Kidneys
Esophagus
Rectum
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6
Q

What intraperitoneal organs are injured most commonly in order?

A

Spleen
Liver
Small bowel

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7
Q

What is the difference in the type of damage caused by high and low velocity GSWs?

A 
High = more kinetic force
Slow = more shearing and cutting
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8
Q

What determines the speed of assessing whether internal bleeding is present?

A

Hypotensive = now

Hemodynamically stable and no peritoneal signs = later

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9
Q

Why is assessing the distance from the shooter important in GSW?

A

If shotgun, the damage decreases significantly the farther the shooter is

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10
Q

After stripping the patient and performing a thorough secondary exam, what should be done immediately?

A

Cover in blankets to prevent hypothermia

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11
Q

Laceration of the perineum, vagina, rectum, or buttocks in the trauma patient may suggest what injury?

A

Open pelvic fracture

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12
Q

When is auscultation of the abdomen most beneficial in the assessment of the traumatic abdomen?

A

When it changes over time

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13
Q

Why should manipulation of the traumatic pelvis be limited to one time?

A

May dislodge a clot and precipitate more bleeding

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14
Q

Should pelvic stability be performed in patients with shock?

A

No

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15
Q

What are the signs that a foley catheter should not be placed in a traumatic pelvis? (3)

A

High riding prostate
Blood at the urethral meatus
Perineal hematoma

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16
Q

When should a NG tube or Nasopharyngeal tube NEVER be used?

A

If suspecting a basilar skull fracture or ina midface injury

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17
Q

What is the role of NG tubes in the trauma pt?

A

Decreases gastric distention and reduces chances of aspiration

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18
Q

What is the only contraindication to performing the FAST exam?

A

Existing indication for laparotomy

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19
Q

What are the indications to perform advanced imaging on a hemodynamically stable patient? (5)

A
  • Change in sensorium or sensation
  • Injury to spine or adjacent structures
  • Equivocal physical exam
  • Lap belt sign
  • Prolonged loss of contact with pt (e.g. anesthesia)
20
Q

Penetrating trauma above what anatomic landmark requires a CXR?

A

Umbilicus

21
Q

While performing a DPL, what findings indicate the need for laparotomy?

A

Blood, bile, or food material in the catheter

22
Q

What are the contraindications to a DPL? (4)

A
  • Cirrhosis
  • Obesity
  • Previous abdominal surgeries
  • Coaqgulopathy
23
Q

What amount of fluids is used in DPL?

A

1000 mL

24
Q

When performing a DPL, what microscopic findings indicate a positive DPL? (3)

A
  • RBCs over 100,000
  • 500 WBCs
  • Gram stain +
25
Q

In the absence of hepatic or splenic injuries, the presence of free fluid in the abdominal cavity suggests what?

A

Injury to the GI tract or its mesentery

26
Q

What organs can CT scans miss lacerations to? (3)

A

Pancreas
Diaphragm
Some GI

27
Q

Suspected urinary injuries are best evaluated by what imaging? What if this is not available?

A

CT

IV pyelogram

28
Q

If a trauma patient needed to be transported to another facility, should imaging be obtained?

A

No

29
Q

What are the four indications for laparotomy for penetrating abdominal wounds?

A
  • hemodynamically abnormal pt
  • GSW with transperitoneal trajectory
  • Signs of peritoneal injury
  • Signs of fascia penetration
30
Q

How sensitive are serial exams in detecting abdominal injury?

A

upper 90%

31
Q

What is the chance of significant abdominal organ injury with GSWs that penetrate the peritoneum?

A

98%+

32
Q

If the duodenum is ruptured, where will air accumulate and be seen on x-ray?

A

Retroperitoneal

33
Q

What is the most common mechanism of pancreatic injury?

A

Smashed against the vertebral column

34
Q

What is the role of amylase in detection of pancreatic injuries?

A
  • May not be elevated early

- May be from other sources

35
Q

What are the two major types of urethral injuries?

A
  • Posterior = above the urogenital diaphragm

- Anterior = Below the urogenital diaphragm

36
Q

Why are hollow viscus injuries hard to diagnose?

A

They may only produce minimal hemorrhage

37
Q

What determines if a patient with a solid organ injury needs an emergent laparotomy?

A

If hemodynamically stable and no signs of continued bleed, can watch

38
Q

Pelvic fractures with hemorrhage often have disruption of what tissue planes? (2)

A

Posterior osseous ligaments and pelvic floor

39
Q

What are the four major mechanisms/classifications of pelvic injuries?

A
  1. AP compression
  2. Lateral compression
  3. Vertical shear
  4. Complex (combination) pattern
40
Q

Why do AP pelvic compression injuries typically produce urethral injuries?

A

Pubis symphysis is displaced and shears the urethral

41
Q

What type of pelvic fracture is the least likely to be lethal? Why?

A

Lateral, since there is generally no disruption of pelvic vasculature

42
Q

What is the anatomic site of application for a pelvic binder?

A

At the level of the greater trochanters

43
Q

What are the stabilizing measures for a pelvic fracture?

A

Pelvic binder and fluids

44
Q

What is a common complication of pelvic binders that needs to be watched for?

A

Skin breakdown

45
Q

What is the decision point for determining if a hemorrhaging pelvic fracture needs a laparotomy vs angiography?

A

If there is gross intraperitoneal blood, then laparotomy

46
Q

Is it more helpful to have a full or empty bladder when performing a fast exam? why?

A

Full–helps to delineate intraperitoneal fluid

A1 (32 decks)

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