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ATLS > Chapter 5- Abdominal/ Pelvic Trauma > Flashcards

Chapter 5- Abdominal/ Pelvic Trauma Flashcards

1
Q

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

A

Thoraco-abdomen

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2
Q

What level does the diaphragm rise to during expiration

A

4th ICS

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3
Q

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

A

flank

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4
Q

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

A

back

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5
Q

what organs are retroperitoneal

A

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

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6
Q

why is it difficult to diagnose injuries to the retroperitoneum

A

difficult to see on FAST, not sampled by DPL

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7
Q

what organs are in the pelvic cavity

A

rectum, bladder, iliac vessels, female reproductive

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8
Q

most frequently injured organ from blunt abdominal trauma

A

spleen

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9
Q

other organs injured by blunt abdominal trauma

A

liver, small bowel (also consider retroperitoneal hematoma)

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10
Q

most common organ injured by penetrating abdominal trauma

A

liver

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11
Q

other organs injured by penetrating abdominal trauma

A

small bowel, diaphragm, colon

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12
Q

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

A

beyond 10 feet/ 3 meters

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13
Q

why should hypothermia be prevented

A

contributes to coagulopathy and ongoing bleeding

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14
Q

loss of bowel sounds may indicate what

A

ileus from free intraperitoneal blood or GI contents

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15
Q

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

A

No- may cause unecessary further pain

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16
Q

a high riding prostate gland is a sign of what

A

significant pelvic fracture

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17
Q

PE signs of a pelvic fracture

A

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

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18
Q

what PE signs are evidence of a rupture urethra

A

high riding prostate, scrotal hematoma, blood at uretral meatus

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19
Q

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

A

no, as it can cause further hemorrhage

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20
Q

who are foley catheters to not be placed in

A

patients with a perineal hematoma or high riding prostate

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21
Q

what can cause lacs of the vagina

A

bony fragments from pelvic fractures or penetrating wounds

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22
Q

why are gastric tubes inserted

A

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

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23
Q

what does presence of blood in gastric conetents suggest

A

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

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24
Q

When should a gastric tube be inserted via the mouth

A

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

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25
Q

goals on inserting a urinary cath

A

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

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26
Q

gross hematuria is a sign of what

A

trauma to GU tract and nonrenal intrabdominal organs

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27
Q

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

A

No

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28
Q

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

A

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

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29
Q

Contraindication to performed FAST/ DPL

A

existing indication for lapartotomy

30
Q

What does FAST stand for?

A

Focused Assessment Sonography in Trauma

31
Q

Where are FAST scans done?

A

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

32
Q

When should FAST exams be performed

A

initially then 30 minutes later to monitor progressive hemoperitoneum

33
Q

What transducer is used for FAST

A

low frequency 3.5 MHz transducer

34
Q

What color is fluid in the heart on FAST

A

black

35
Q

Where do you obtain the RUQ view for FAST

A

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

36
Q

what is morrison’s pocuh?

A

hepatorenal fossa

37
Q

Where is the LUQ view obtained for FAST

A

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

38
Q

DPL indication

A

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

39
Q

Relative C/I to DPL

A

previous abdominal operations, morbid obesity

advanced cirrhosis, preexisting coagulopathy

40
Q

DPL approach preferred in pelvic fracture

A

supraumbilical approach

41
Q

typical approach for DPL

A

infraumbilical technique

42
Q

Findings from DPL that indicate need for laparotomy

A

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

43
Q

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

A

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)

44
Q

CT is only indicated in what type patients

A

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

45
Q

when should urethrography be performed

A

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.

46
Q

What is a intraperitoneal or extraperinteal bladder rupture best diagnosed by

A

cystogram or CT cystography

47
Q

what are suspected urinary system injuries best evaluated by

A

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

48
Q

how are most GSWs to the abdomen managed

A

exploratory laparotomy

49
Q

indications for laparotomy in patients with penetrating abdominal wounds

A

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

50
Q

what is double contrast

A

IV and oral

51
Q

what is triple contrast

A

IV, oral, and rectal

52
Q

way to evaluate flank and back injuries in relatively asymptomatic patients

A

serial PEs

double or triple contrast CTs

53
Q

indications for laparotomy

A

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

54
Q

which hemidiphragm is most commonly injured

A

left (posterolateral)

55
Q

signs of tear in diaphragm

A

elevation or “blurring” of hemidiaphragm, hemothorax, abnormal gas shadow

56
Q

who is duodenal rupture common in

A

unrestrained drivers in frontal-impact MVA

direct blow to abomdne (bike handlebars)

57
Q

signs of duodenal injury

A

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

58
Q

studies indicated for patients at high risk for duodenal injury

A

upper GI x-ray series or double contrast CT

59
Q

does a normal serum amylase level exclude pancreatic trauma

A

No

60
Q

most common cause of pancreatic injuries

A

direct epigastric blow that compresses organ against vertebral column

61
Q

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

A

it may not, should repeat CT if suspected

62
Q

what typically causes hollow viscus injuries

A

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

63
Q

msot common force that causes a pelvic fracture

A

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

64
Q

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

A

no since the pelvic colume is actually compressed

65
Q

When does an AP compression pelvic injury occur

A

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

66
Q

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

A

laparotomy

67
Q

what is a positive DPL

A

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

68
Q

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

A

No (outside peritoneum)

69
Q

What should be done for DPL

A

decompress stomach and urinary bladder

70
Q

complications from DPL

A

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

ATLS (6 decks)

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