Module 7 : Trauma Flashcards
what is the clinical presentation of patients with trauma
- dependent on severity, area, time line
- hemodynamically unstable (shock)
- pain and tenderness over area
- rigid abdomen
what is a correlating lab test
- hematocrit
what is hematocrit
- volume of red blood cells in whole blood sample
- loss of blood causes a low hematocrit
what is the primary modality to see bleeds
CT
how does timing affect US look of hemorrhage or hematoma
- acute = echogenic (debris)
- within 1st week = decreased in echogenicity
- 2-3 weeks post trauma = less defined
what is the treatment for trauma
- hepatic, renal, splenic trauma managed conservatively in hemodynamically stable patients
- ureteric trauma = nephrostomy stents
- surgical repair
- paracentisis
is the liver susceptible to hemorrhage what lobe most affected
- yes
- right posterior segment
how is liver trauma treated
- conservatively is not in shock
what are 5 findings of liver trauma
- perivascular laceration
- sub capsular and pericapsular bleed
- isolated hematoma
- liver fracture
- hemoperitoneum
what is the most common cause of spleen trauma
- MVA or rib trauma
which organ is most commonly affected by trauma
- spleen
what does the shape of the fluid collection around the spleen tell you
- crescent shape = sub capsular
- irregular = perisplenic
- check flanks and morissons pouch
what is the most common cause of biliary tree and pancreas trauma
- percutaneous procedures and liver biopsies
what 5 things usually result form biliary or panc trauma
- hemobilia
- jaundice
- pneumobilia
- biloma
- pseudocysts
what can kidney trauma be caused by
- blunt or penetrating injury
what might be involved in kidney trauma
- parenchyma or extend into collecting system
what are the 2 types of kidney hematoma
- subcapsular
- intrarenal
what are kidney lacerations
- linear defects
what are perirenal collections
- urinomas
- hematomas
what is 70% of bladder trauma associated with
- pelvic fracture
- rupture
- look for large fluid collections
is spontaneous hemorrhage of adrenal common or uncommon
- not common
what three things could cause spontaneous hemorrhage of adrenal
- anticoagulation
- stress
- blood abnormalities
characteristics of post traumatic hemorrhage of adrenal gland
- predominantly in medulla
- right more than left
- bright ehcogenic mass more anechoic and smaller over time
what does bilateral trauma of adrenal gland put you at risk for
- adrenal insufficiency
what is the most common cause of adrenal mass in neonates
- adrenal hemorrhage
characteristics of adrenal hemorrhage in infants
- traumatic delivery
- bilateral
- decreased hematocrit increased bilirubin
- jaundice
where is hematoma localized to in GI tract
- submucosa
where does free fluid collect in peritoneum in supine
- pelvis
- paracolic gutters
- free fluid conforms to surrounding organs
what are the two types of free fluid in peritoneum
- transudative and exudative
what is a FAST scan
- focused assessment with sonography
- screening for intra abdominal injuries
- free fluid detection suggests significant injury, patient goes for laparotomy
what are 4 traumatic injuries to the retroperitoneum
- hematomas = psoas muscle, perinephric space
- abscesses = perinephric
- urinomas = interventional procedures, hypo echoic collection
- lymphocytes = post surgery, anechoic
why do hernias occur
- weakening in the abdominal wall muscles
- viscera protrudes through
what are the two types of hernias
congenital
- aquired
what are the 2 acquired hernias
- gastroschisis
- omphalocele
what are the risk factors for getting an acquired hernias
- elderly
- excessive weight gain or loss
- surgery
- pregnancy
- heavy lifting
- chronic constipation
- sudden twists
- pulls or muscle strains
what are the signs and symptoms of hernias
- asymptomatic
- palpable mass or buldge
- pain or burning
- heaviness around scrotum
what is a reducible hernia
can be pushed back into place
what is an incarcerated hernia
- irreducible
- trapped
what is a strangulated hernia
- blood supply cut off/tisssue swells
- medical emergency
what are 8 locations of hernia
- umbilical
- epigastric
- inguinal
- spigelian
- lumbar
- ventral
- femoral
- incisional
where do epigastric hernias occur
- widest part of the lineament alba
what is the most common location of hernias
- inguinal
- if unilateral on the right
what are the 2 types of inguinal hernias
- direct
- indirect
what is a direct inguinal hernia
- acquired
- older men
- due to weakened canal floor
- medial to inferior epigastric artery
what is an indirect inguinal hernia
- congenital
- most common
- exits via deep inguinal ring
- passes through length of canal
what is a spigelian hernia
- spontaneous lateral abdominal wall
is a lumbar hernia common or uncommon
- uncommon
what is a femoral hernia
- groin pain
- mass medial to femoral vein
what are the 3 surgical interventions for hernia s
- herniorrhapy = large incision muscle sewn over defects
- hernioplasty = incision , prosthetic mesh inserted
- laparoscopic - small incision
what are 5 causes of rectus sheath hematoma
- trauma
- surgery
- vigorous abdominal contractions
- intense straining g
- spontaneous
