Chapter 5- Abdominal/ Pelvic Trauma

Question 1

area that is inferior to trans-nipple line, infrascpaular and includes diaphragm, liver, spleen, stomach

Answer 1

Thoraco-abdomen

Question 2

What level does the diaphragm rise to during expiration

Answer 2

4th ICS

Question 3

areas between anterior and posterior axillary lines from 6th ICS to iliac crest.

Answer 3

flank

Question 4

area posterior to posterior axillary line and goes from tip of scapula to iliac crest

Answer 4

back

Question 5

what organs are retroperitoneal

Answer 5

abdominal aorta, inferior vena cava, duodenum, pancreas, kidneys, uterus, parts of the colon

Question 6

why is it difficult to diagnose injuries to the retroperitoneum

Answer 6

difficult to see on FAST, not sampled by DPL

Question 7

what organs are in the pelvic cavity

Answer 7

rectum, bladder, iliac vessels, female reproductive

Question 8

most frequently injured organ from blunt abdominal trauma

Answer 8

spleen

Question 9

other organs injured by blunt abdominal trauma

Answer 9

liver, small bowel (also consider retroperitoneal hematoma)

Question 10

most common organ injured by penetrating abdominal trauma

Answer 10

liver

Question 11

other organs injured by penetrating abdominal trauma

Answer 11

small bowel, diaphragm, colon

Question 12

at what length does the liklihood of major visceral injuries decrease with GSWs

Answer 12

beyond 10 feet/ 3 meters

Question 13

why should hypothermia be prevented

Answer 13

contributes to coagulopathy and ongoing bleeding

Question 14

loss of bowel sounds may indicate what

Answer 14

ileus from free intraperitoneal blood or GI contents

Question 15

If a patient has pain on percuss should further palpation be done for rebound tenderness?

Answer 15

No- may cause unecessary further pain

Question 16

a high riding prostate gland is a sign of what

Answer 16

significant pelvic fracture

Question 17

PE signs of a pelvic fracture

Answer 17

evidence or rupture urethra, limb length discrepancy, rotational deformity of leg w/o obvious fracture

Question 18

what PE signs are evidence of a rupture urethra

Answer 18

high riding prostate, scrotal hematoma, blood at uretral meatus

Question 19

Should you perform manual manipulation of the pelvis if there is an obvious fracture

Answer 19

no, as it can cause further hemorrhage

Question 20

who are foley catheters to not be placed in

Answer 20

patients with a perineal hematoma or high riding prostate

Question 21

what can cause lacs of the vagina

Answer 21

bony fragments from pelvic fractures or penetrating wounds

Question 22

why are gastric tubes inserted

Answer 22

relieve acute gastric dilation, decompress teh stomach before a DPL, remove gastric contents

Question 23

what does presence of blood in gastric conetents suggest

Answer 23

injury to esophagus or upper GI tract (if nasopharyngeal/ oropharyngeal sources excluded)

Question 24

When should a gastric tube be inserted via the mouth

Answer 24

if severe facial fracture/ basilar skull fracture , mid face injury

Question 25

goals on inserting a urinary cath

Answer 25

relieve retnetion, decompress bladder before performing DPL, monitor UOP as sign of tissue perfusion

Question 26

gross hematuria is a sign of what

Answer 26

trauma to GU tract and nonrenal intrabdominal organs

Question 27

does absence of heamturia r/o an injury to the GU tract?

Answer 27

No

Question 28

reasons to perform a retrograde urethrogram to confirm intact urethra before inserting foley

Answer 28

inability to void, unstable pelvic fracture, blood at meatus, scrotal hematoma, perineal eccymoses, high riding prostate

Question 29

Contraindication to performed FAST/ DPL

Answer 29

existing indication for lapartotomy

Question 30

What does FAST stand for?

Answer 30

Focused Assessment Sonography in Trauma

Question 31

Where are FAST scans done?

Answer 31

pericardial sac hepatorenal fossa & morrison's pouch splenorenal fossa pelvis or pouch of Douglas (suprapubic)

Question 32

When should FAST exams be performed

Answer 32

initially then 30 minutes later to monitor progressive hemoperitoneum

Question 33

What transducer is used for FAST

Answer 33

low frequency 3.5 MHz transducer

Question 34

What color is fluid in the heart on FAST

Answer 34

black

Question 35

Where do you obtain the RUQ view for FAST

Answer 35

midaxillary line at 10-11th rib space. visualize diaphragm, liver, kidney, morrison's pouch

Question 36

what is morrison's pocuh?

Answer 36

hepatorenal fossa

Question 37

Where is the LUQ view obtained for FAST

Answer 37

midaxillary at 8th or 9th ICS. visualized diaphragm, spleen, kidney

Question 38

DPL indication

Answer 38

hemodynamically normal patients w/ blunt injury when US or CT is not available hemodynamically unstable pts w/ multiple blunt injuries / penetrating useful too

Question 39

Relative C/I to DPL

Answer 39

previous abdominal operations, morbid obesity | advanced cirrhosis, preexisting coagulopathy

Question 40

DPL approach preferred in pelvic fracture

Answer 40

supraumbilical approach

Question 41

typical approach for DPL

Answer 41

infraumbilical technique

Question 42

Findings from DPL that indicate need for laparotomy

Answer 42

free aspiration of blood, GI contents, vegetable fibers, bile

Question 43

If greater than 10 mL of blood or GI contents aren't aspirated from DPL initially what is done

Answer 43

lavage is performed with 1000 mL of warmed isotonic crystalloid solution (10 mL/kg in kid) then make sure fluid mixes with peritoneal (log rolling, head down/ up positions)

Question 44

CT is only indicated in what type patients

Answer 44

hemodynamically normal patients who there is no apparent indication for an emergency laparotomy

Question 45

when should urethrography be performed

Answer 45

before inserting an indwelling urinary catheter when urethral injury is suspected (insert undiluted contrast through 8 French urinary cath secured in meatal fossa) X-ray taken with A/P projection w/ penis stretched towards shoulder.

Question 46

What is a intraperitoneal or extraperinteal bladder rupture best diagnosed by

Answer 46

cystogram or CT cystography

Question 47

what are suspected urinary system injuries best evaluated by

Answer 47

contrast-enhanced CT scan (if not available then Intravenosu pyelogram)

Question 48

how are most GSWs to the abdomen managed

Answer 48

exploratory laparotomy

Question 49

indications for laparotomy in patients with penetrating abdominal wounds

Answer 49

hemodynamically abnormal GSW w/ transperitoneal trajectory signs of peritoneal irritation signs of fascia penetration

Question 50

what is double contrast

Answer 50

IV and oral

Question 51

what is triple contrast

Answer 51

IV, oral, and rectal

Question 52

way to evaluate flank and back injuries in relatively asymptomatic patients

Answer 52

serial PEs | double or triple contrast CTs

Question 53

indications for laparotomy

Answer 53

blunt abdominal trauma w/ HPOTN, +FAST, DPL HPOTN + penetrating abd wound GSW into peritoneal/ vascular retropertoneum evisceration bleeding from stomach, rectrum, GU peritonitits free air, retroperitoneal air,hemidiaphragm rupture

Question 54

which hemidiphragm is most commonly injured

Answer 54

left (posterolateral)

Question 55

signs of tear in diaphragm

Answer 55

elevation or "blurring" of hemidiaphragm, hemothorax, abnormal gas shadow

Question 56

who is duodenal rupture common in

Answer 56

unrestrained drivers in frontal-impact MVA | direct blow to abomdne (bike handlebars)

Question 57

signs of duodenal injury

Answer 57

bloody gastric aspirate, retroperitoneal air on flat plate x-ray or abdominal CT

Question 58

studies indicated for patients at high risk for duodenal injury

Answer 58

upper GI x-ray series or double contrast CT

Question 59

does a normal serum amylase level exclude pancreatic trauma

Answer 59

No

Question 60

most common cause of pancreatic injuries

Answer 60

direct epigastric blow that compresses organ against vertebral column

Question 61

Does double contrast CT identify significant pancreatic trauma up to 8 hours post injury

Answer 61

it may not, should repeat CT if suspected

Question 62

what typically causes hollow viscus injuries

Answer 62

blunt injury to the intestines from sudden deceleration w/ subsequent tearing near a fixed point of attachment

Question 63

msot common force that causes a pelvic fracture

Answer 63

lateral compression (closed) . lead to inernal rotation of the involved hemipelvis

Question 64

is life threatening hemorrhage common in lateral compression (closed) pelvic injury

Answer 64

no since the pelvic colume is actually compressed

Question 65

When does an AP compression pelvic injury occur

Answer 65

auto-ped, motocycle, direct crush injury, fall from height >12 feet. opening of pelvic can lead to significant hemorrhage from posterior pelvic venous complex

Question 66

IF there is gros sintraperitoneal blood with a pelvic fracture what is indicated?

Answer 66

laparotomy

Question 67

what is a positive DPL

Answer 67

Gross blood aspirated, >100,000 RBCs, >500 WBCs, positive gram stain for food fibers/ bacteria

Question 68

does a negative DPL exclude retroperitoneal injuries such as pancreatic/ duodenal

Answer 68

No (outside peritoneum)

Question 69

What should be done for DPL

Answer 69

decompress stomach and urinary bladder

Question 70

complications from DPL

Answer 70

hemorrhage, peritonitis, laceration of bladder, injury to abdominal/ retroperitoneal structure, wound infection at site