S21C260 - Abdominal Trauma

Question 1

Pancreatic injury

Answer 1

-usually from hitting handlebars, rapid deceleration, or unrestrained drivers who hit the steering wheel

Question 2

Hollow visceral rupture

Answer 2

-can occur from falls from height

Question 3

Mechanisms suspicious of abdo injury:

Answer 3

• abdo pain, tenderness, distension
• mechanism of injury
• lower chest or pelvic injury
• high-speed collisions, esp if deformity to vehicle, unrestrained
• MVC with fatalities
• unprotected injury
• presence of distracting injuries
• decreased LOC
• pain-masking drugs
• inability to tolerate a delayed dx (elderly…)

Question 4

Diagnostic modalities of blunt abdo trauma

Answer 4

• repeat serial exams
• u/s FAST - 2 FASTS 6h apart is best with serial exams
• CT scan - gold standard
• DPL - not used
• laparoscopy - also not used in ED

Question 5

Penetrating Abdominal Trauma: work-up

Answer 5

• do not do digital probing or contrast and radiographic imaging
• do local wound exploration, if anterior fascia is NOT violated then the pt can be safely discharged
• if anterior fascia violated, proceed with serial exams, more imaging, or exploratory laparotomy
• CT scan with triple contrast (PO, IV, PR)
• FAST: PPV 90%, however one third of neg FAST will have injuries that require laparotomy for GSW

-exploratory laparotomy is gold standard, indications are: HoTN, abdo wall disruption, peritonitis, air on xr/ct, + FAST in hemodynamically unstable pt, and some organ specific findings on CT

Question 6

Hepatic injury (hematoma/laceration)

Answer 6

-grade I-III often can be managed non-operatively

Question 7

Splenic Injury

Answer 7

• non-operative management has failure rate of 10-15%

- non-operative management for pts