ATLS-Abdominal Trauma Flashcards
Penetrating injuries above and below what landmarks indicate the need to assess for intraperitoneal injury?
Below the nipple line, and above the perineum
What are the boundaries of the anterior abdomen?
Superior = costal margins Inferior = inguinal ligaments and pubis symphasis Laterally = anterior axillary lines
What are the boundaries of the thoacoabdomen?
Superior = Nipple line/infrascapular line Inferior = costal margins
What diaphragm rises to what rib level during full expiration?
4th rib
What are the components of the SAD PUCKER mnemonic for the retroperitoneal organs?
Supra Adrenal glands Aorta Duodenum Pancreas Ureters Colon (ascending and descending) Kidneys Esophagus Rectum
What intraperitoneal organs are injured most commonly in order?
Spleen
Liver
Small bowel
What is the difference in the type of damage caused by high and low velocity GSWs?
High = more kinetic force Slow = more shearing and cutting
What determines the speed of assessing whether internal bleeding is present?
Hypotensive = now
Hemodynamically stable and no peritoneal signs = later
Why is assessing the distance from the shooter important in GSW?
If shotgun, the damage decreases significantly the farther the shooter is
After stripping the patient and performing a thorough secondary exam, what should be done immediately?
Cover in blankets to prevent hypothermia
Laceration of the perineum, vagina, rectum, or buttocks in the trauma patient may suggest what injury?
Open pelvic fracture
When is auscultation of the abdomen most beneficial in the assessment of the traumatic abdomen?
When it changes over time
Why should manipulation of the traumatic pelvis be limited to one time?
May dislodge a clot and precipitate more bleeding
Should pelvic stability be performed in patients with shock?
No
What are the signs that a foley catheter should not be placed in a traumatic pelvis? (3)
High riding prostate
Blood at the urethral meatus
Perineal hematoma
When should a NG tube or Nasopharyngeal tube NEVER be used?
If suspecting a basilar skull fracture or ina midface injury
What is the role of NG tubes in the trauma pt?
Decreases gastric distention and reduces chances of aspiration
What is the only contraindication to performing the FAST exam?
Existing indication for laparotomy
What are the indications to perform advanced imaging on a hemodynamically stable patient? (5)
- 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)
Penetrating trauma above what anatomic landmark requires a CXR?
Umbilicus
While performing a DPL, what findings indicate the need for laparotomy?
Blood, bile, or food material in the catheter
What are the contraindications to a DPL? (4)
- Cirrhosis
- Obesity
- Previous abdominal surgeries
- Coaqgulopathy
What amount of fluids is used in DPL?
1000 mL
When performing a DPL, what microscopic findings indicate a positive DPL? (3)
- RBCs over 100,000
- 500 WBCs
- Gram stain +
In the absence of hepatic or splenic injuries, the presence of free fluid in the abdominal cavity suggests what?
Injury to the GI tract or its mesentery
What organs can CT scans miss lacerations to? (3)
Pancreas
Diaphragm
Some GI
Suspected urinary injuries are best evaluated by what imaging? What if this is not available?
CT
IV pyelogram
If a trauma patient needed to be transported to another facility, should imaging be obtained?
No
What are the four indications for laparotomy for penetrating abdominal wounds?
- hemodynamically abnormal pt
- GSW with transperitoneal trajectory
- Signs of peritoneal injury
- Signs of fascia penetration
How sensitive are serial exams in detecting abdominal injury?
upper 90%
What is the chance of significant abdominal organ injury with GSWs that penetrate the peritoneum?
98%+
If the duodenum is ruptured, where will air accumulate and be seen on x-ray?
Retroperitoneal
What is the most common mechanism of pancreatic injury?
Smashed against the vertebral column
What is the role of amylase in detection of pancreatic injuries?
- May not be elevated early
- May be from other sources
What are the two major types of urethral injuries?
- Posterior = above the urogenital diaphragm
- Anterior = Below the urogenital diaphragm
Why are hollow viscus injuries hard to diagnose?
They may only produce minimal hemorrhage
What determines if a patient with a solid organ injury needs an emergent laparotomy?
If hemodynamically stable and no signs of continued bleed, can watch
Pelvic fractures with hemorrhage often have disruption of what tissue planes? (2)
Posterior osseous ligaments and pelvic floor
What are the four major mechanisms/classifications of pelvic injuries?
- AP compression
- Lateral compression
- Vertical shear
- Complex (combination) pattern
Why do AP pelvic compression injuries typically produce urethral injuries?
Pubis symphysis is displaced and shears the urethral
What type of pelvic fracture is the least likely to be lethal? Why?
Lateral, since there is generally no disruption of pelvic vasculature
What is the anatomic site of application for a pelvic binder?
At the level of the greater trochanters
What are the stabilizing measures for a pelvic fracture?
Pelvic binder and fluids
What is a common complication of pelvic binders that needs to be watched for?
Skin breakdown
What is the decision point for determining if a hemorrhaging pelvic fracture needs a laparotomy vs angiography?
If there is gross intraperitoneal blood, then laparotomy
Is it more helpful to have a full or empty bladder when performing a fast exam? why?
Full–helps to delineate intraperitoneal fluid
