Ch. 42 Penetrating Abdominal Trauma

Question 1

What three physical exam findings independently mandate immediate operative intervention in patients with penetrating abdominal trauma?

Answer 1

1. Hypotension
2. Peritonitis
3. Evisceration

Question 2

What are the two most common organs injured following a penetrating abdominal injury?

Answer 2

1. Small bowel
2. Liver

Question 3

What specific injuries must be ruled out with GSW that travels across the pelvis?

Answer 3

A transpelvic GSW is at increased risk of injuring the ureters, bladder, iliac vessels, rectum, and vagina. Patients with these injuries should undergo a proctoscopy to r/o injury to the rectum, + CT scan ob the abdomen and pelvis.

Females should undergo vaginal exam.

Question 4

In the absence of hypotension, peritonitis, or evisceration, what imaging is recommended for a pt with penetrating abdominal trauma?

Answer 4

CT of the badomen and pelvis with IV contrast

Question 5

Are diagnostic peritoneal lavage (DPL) and FAST helpful studies in patients with penetrating abdominal trauma?

Answer 5

The FAST exam is more useful for pts following blunt trauma.

Primary utility for penetrating abdominal trauma is to r/o cardiac tamponade.

**NOT HELPFUL FOR ID-ing injury to retroperitoneal structures**

DPL is also more useful for blunt abdominal trauma, specifically if FAST is unavailable

Question 6

What is the “Lethal Triad of Death” in trauma?

Answer 6

Acidosis, Hypothermia, Coagulopathy

If left uncorrected, could lead to:

Hemorrhage, Hypoxia, Contamination, SIRS/Sepsis, Resuscitation

DEATH

Question 7

What is Abdominal Compartment Syndrome? Who is at risk?

Treatment?

Answer 7

Patients with multiple traumatic injuries, particularly intra-abdominal or retroperitoneal, who have received large volumes of fluids and blood products are at risk of developing intra-abdominal HTN (IAH) and Abdominal Compartment Syndrome (ACS).

Suspect ACS in any severely injured pt who demonstrates decreased urine output and increasing vasopressor support

Treatment: take pt to OR and perform decompressive lapartomy by reopening the abdominal fascia and leaving the wound open

Question 8

Penetrating abdominal trauma: Initial mgmt

Answer 8

Penetrating abdominal trauma: Initial mgmt

1. Start with ABCs
2. Initiate massive transfusion protocol in all unstable pts with suspected major blood loss, if available
3. Consider permissive hypotension in pts with penetrating torso trauma
   
   1. Overaggressive fluid replacement can raise BP and create dilutional coagulopathy