EM Trauma 3 (abdominal trauma)

Question 1

remarks on abdominal trauma

Answer 1

abdominal trauma accounts for 15-20% of all trauma deaths

liver is the most frequently injured abdominal organ

SPLEEN is the most frequently injured intra-abdominal organ from SPORTS accidents

Question 2

mechanism of blunt abdominal trauma

Answer 2

1. MVC
2. falls

Question 3

remarks on penetrating abdominal trauma

Answer 3

assume any penetrating injury to the chest, pelvis, flank, or back to have penetrated the abdominal cavity until proven otherwise

Question 4

remarks on solid organ injuries

Answer 4

e.g. hepatic and splenic injuries

any blunt abdominal trauma patient with diffuse peritonitis or who is hemodynamically unstable should be taken urgently for laparotomy

nonoperative management is now the treatment of choice in hemodynamically stable blunt hepatic and splenic injured patients “irrespective of the grade of injury, patient age, or the presence of associated injuries”

Question 5

noninvasive gold standard study for the evaluation of abdominal injury

Answer 5

abdominopelvic CT with IV contrast

Question 6

some absolute indications for laparotomy for blunt abdominal trauma

Answer 6

BLUNT
Hypotension in blunt injury to the anterior abdomen
Peritonitis
Positive FAST in hemodynamically unstable patient

Question 7

some absolute indications for laparotomy for penetrating abdominal trauma

Answer 7

PENETRATING
Hypotension in penetrating injury to the abdomen, back, and flank
GI evisceration

Question 8

reversal agents for medication-induced coagulopathy

Answer 8

protrombin complex concentrate for warfarin or factor Xa inh (rivaroxaban, apixaban, edoxaban)

idaru-cizu-mab for dabigatran

Question 9

Pain with solid organ injury may be referred to the _____

Answer 9

shoulder/scapular region

Question 10

Examples of retroperitoneal organ injuries

Answer 10

Pancreatic injuries
Duodenal injuries

Question 11

Remarks on pancreatic injuries

Answer 11

Pancreatic injuries
- assoc’d with significant morbidity and mortality
- often occurs from rapid deceleration

Question 12

Remarks on duodenal injuries

Answer 12

Duodenal injuries
- may be relatively asymptomatic and go undiagnosed
- as duodenal hematoma expands, signs and symptoms of obstruction may develop (abdominal pain, distention, and vomiting)
- duodenal rupture generally occurs following high-velocity deceleration

Question 13

Remarks on abdominal stab injuries

Answer 13

1. Mandatory exploration for patients sustaining a stab wound to the abdomen has yielded unacceptably high rates of nontherapeutic laparotomy.
2. The emergency hysician or consultant surgeon may locally explore anterior abdominal stab wounds to assess for violation of the peritoneum.

Question 14

Trial regarding tranexamic acid in trauma

Answer 14

‼️CRASH-2 Trial‼️
- The risk of death was most reduced with tranexamic acid administration within 1 hour and in those with the most severe hemorrhagic shock
- whereas treatment beyond 3 hours implicated an increased risk of death