Emergency Abdominal Surgery

Question 1

What does the PRIMARY survey include in any trauma?

Answer 1

• Airway
• Breathing
• Circulation
• Disability

Question 2

*** What does the SECONDARY survey include in trauma?

Answer 2

• MECHANISM OF INJURY (blunt, penetrating, and force)

- exposure of patient

Question 3

If a bullet is “through and through” does this normally cause more or less damage?

Answer 3

less bc some of the energy has left the system

Question 4

*** What is the key reason for learning the mechanism of injury?

Answer 4

• ENERGY

KE= 1/2 M*V^2

Question 5

Is mass or velocity the more important parameter of kinetic energy imparted in trauma?

Answer 5

• velocity bc it is the squared parameter.

Question 6

*** What 3 things must we get on board for hemodynamic stabilization?

Answer 6

1. FLUIDS (whole blood fluid is best)
2. MONITORS
3. DRUGS (only those that are absolutely needed and usually only used in end stage for hypovolemic shock).

Question 7

Should we put a tube for monitoring in most places that we can in trauma?

Answer 7

YES! We want COMPLETE CONTROl of our patient!

Question 8

What are the important types of injury in the abdomen?

Answer 8

• LOW velocity/BLUNT injury= usually do NOT require surgery. Ex. punched in the stomach.
• LOW velocity/PENETRATING injury= Ex. knife stab wound.
• HIGH velocity/PENETRATING injury (also called “missile injuries”)= usually require surgery.

Question 9

Should you pull the knife out of a stab wound?

Answer 9

Not unless you are prepared to take him to surgery in order to stop the bleeding or correct the tamponade. Stabilize the weapon and prevent the patient from looking at their wound.

Question 10

If you get a stab wound directly beneath your xiphoid process, is this a bad spot?

Answer 10

YES bc your pericardium is right there!

*Don’t give fluids for tamponade bc this will make it worse.

Question 11

What 3 modalities can we use to assess a low velocity abdominal injury?

Answer 11

• CT Scan
• peritoneal lavage
• FAST scan (focused assessment with sonography for trauma; looking at 4 areas where fluid can collect).

Question 12

What is a peritoneal lavage?

Answer 12

• catheter placed into the abdomen to deliver about a liter of fluid into the abdominal cavity and then collected to assess whether a pt required surgery.

Question 13

What things would indicate a positive peritoneal lavage, and thus indicate the need for surgery?

Answer 13

• more than 100k RBCs
• more than 500 WBCs
• bacteria
• amylase
• lipase

Question 14

What 3 things indicate OR?

Answer 14

• peritoneal lavage/FAST +
• hemodynamic instability
• removal of foreign body

Question 15

What is the difference between a hollow tip and copper jacketed bullet?

Answer 15

• hollow tip “mushes up” when it hits you causing more damage.
• in the military however, by geneva convention, all bullets must be copper jacketed.

Question 16

How does “yaw” relate to velocity?

Answer 16

• a higher velocity bullet (like a rifle bullet) will yaw (tumble on its axis) more causing MORE DAMAGE due to more energy imparted.
• treatment is OR.

Question 17

What must be done for every high velocity trauma patient?

Answer 17

• retroperitoneal/retrogram contrast to take a look at the retroperitoneum.

Question 18

Do we explore for bullets to be removed?

Answer 18

Not unless they are at a location that will rub against a structure causing further damage. Most times they will be walled off and eventually work their way out of the body.

Question 19

What is an open abdomen?

Answer 19

• when there is so much infection that closing it is setting it up for disaster.
• so we keep it open to allow the infection to drain.
• very difficult to manage bc you will have a LOT of insensible fluid loss.