Chapter 5 - Abdominal And Pelvic Trauma Flashcards
What are indications for laparotomy
Blunt trauma with hypotension / clinical evidence of intraperitoneal bleeding
Hypotension + abdo wound perforating anterior fascia
Gunshot wound traversing peritoneum
Evisceration
Bleeding from GI / GU tract following penetrating trauma
Peritonitis
Free air or hemidiaphragm rupture
Contrast CT indicating need
Aspiration GI contents / veg fibres / bike on DPL or >10ml blood
What is a common diaphragm injury
5-10cm involving left posterolateral hemidiaphragm
What clinical signs might cause you to consider underlying renal injury
Contusion, haematoma or ecchymoses of the back or flank
What are the four types of pelvic injury
AP compression
Lateral compression
Vertical shear
Combine mechanism
Which is the most common type of pelvic injury
Lateral compression injury
what injuries can a direct blow (blunt trauma) cause
compression and crushing injuries to abdominopelvic viscera and pelvic bones . Such forces can cause rupture with secondary haemorrhage and contamination leading to pertionitis
what injuries do penetrating trauma cause
lacerating and tearing tissue damage. Also tissue aviation due to track of missiles in gunshots with higher kinetic energy
which organs are most commonly injured in blunt abdominal trauma
spleen, small blowel and liver as they are movable organs with fixed ligaments
which organs are most commonly injured in penetrating trauma
liver, SB, colon and diaphragm
what type on injury is caused by blasts
several mechanisms including penetrating fragment wounds and blunt trauma from pt being thrown or struck by projectiles
also close to blast causes injuries to tympanic membranes like lung due to overpressure
what information do we need about motor vehicle crash
vehicle speed type of collision e.g. frontal impact, sideswipe intrusion into passenger compartment types of restraints airbag deployment patient position in vehicle status of other occupants
what info do we need about penetrating trauma
type of implement / weapon time of injury distance from assailant (esp shotgun) number of stab wounds/ shots amount of bleeding at scene magnitude and location of abode pain
what is the order of the abdomen exam
inspect, auscletate, percuss, palpate
followed by inspect urethra, pelvis, buttocks, perineal, rectal, vaginal
what findings are suggestive of pelvic fracture
bleeding from urethra / scrotal haemoatoma suggesting ruptured urethra
limb length discrepancy
rotational deformity of leg
what does the mechanically unstable pelvis look like
it migrates cephalad due to muscular pull and rotates outwards due to gravity
how do we place a pelvic binder
should be centred over greater trochanters
why do we perform rectal exam
to identify palpable pelvic fractures, assess sphincter tone and rectal mucosal integrity
what do we have to do if there is blood at the meatus, patient is unable to void, requires pelvic binder, has scrotal haematoma or perineal ecchymosis
retrograde urethrogram
what XR do we perform for pts with multi system blunt rauma
AP CXR
what four regions are scanned in FAST
pericardial sac, hepatorenal fossa, splenorenal fossa, pelvis or pouch of Douglas
what must we do before DPL
urinary and gastric decmpression
when should we use CT
in haemodynamicLLY NORMAL PT WHO HAS NO APPARENT NEED FOR LAPAROTOMY
how do we manage most abdominal gunshot wounds
exploratory laparotomy
when do we typically see duodenal injury
in unrestrained drivers who receive frontal impacts and pts who receive direct blows to abdomen such as bicycle handlebars
how do pancreatic injuries often occur
as a result of direct blow compressing it again vertebrae
when does blunt injury to intestines usually occur
when sudden deceleration causes tearing near fixed point of attachment
