Splenic Salvage procedures, Trauma Flashcards

1
Q

What are the advantages of nonoperative management of splenic injuries?

A

Avoiding immunologic effects and the risks of laparotomy (intraabdominal injuries to pancreas), asplenia (risk of OPSI)

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2
Q

What is the prime determinant in operative versus nonoperative management in splenic injury?

A

Hemodynamic stability

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3
Q

What is a grade I splenic injury?

A

Hematoma with subscapular, <10% surface

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4
Q

What is a grade II splenic injury?

A

Subcapsular hematoma, 10-50% surface area, intraparenchymal hematoma, <5cm;
Laceration: Capsular tear from 1-3cm parenchymal depth

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5
Q

What is a grade III splenic injury?

A

Hematoma - subcapsular >50% surface area or expanding, ruptured or parenchymal hematoma; or intraparenchymal hematoma >5cm or expanding
Laceration >3cm parenchymal depth or involving trabecular vessels.

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6
Q

What is a grade IV splenic injury?

A

Laceration involving segmental or hilar vessels producing major (>25%) devascularization

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7
Q

What is a grade V splenic injury?

A

Completely shattered spleen, or hilar vascular injury with devascularized spleen

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8
Q

General indications for angioembolization for splenic injury

A

Controversial topic, but in general a contrast blush or pooling on CT, a higher grade injury (III +), persistent tachycardia and declining hematocrit are indications

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9
Q

Which criteria increase failure rate of angioembolizaion?

A

Presence of an arteriovenous fistula on CT scan, age >55, hemodynamic instability

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10
Q

Criterion for Nonoperative management of blunt splenic injury

A

Hemodynamic stability, absence of additional injuries requiring operative intervention, transfusion fewer than 2 units

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11
Q

At the time of initial injury, should chemical DVT prophylaxis be used in patients undergoing nonoperative treatment for blunt splenic injury?

A

No, chemical prophylactic anticoagulation is contraindicated.

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12
Q

What is the general consensus regarding resuming normal activities after blunt splenic trauma?

A

After 2-4 months

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13
Q

What is the most common cause of failure of nonoperative management?

A

Bleeding within 4 days on therapy

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14
Q

When is repeat imaging recommending for high grade injuries managed nonoperatively? (grades III-IV)

A

CT scan after 4-6 weeks

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15
Q

If a grade 1 or 2 splenic laceration is encountered during abdominal exploration for another indication, what is the preferred method of splenic repair?

A

Direct application of electrocautery or argon beam coagulator

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16
Q

If a grade 3 splenic laceration is encountered, and patient is stable, what are common options for splenorrhapy?

A

Manual compression, and pledgeted sutures to repair injury or mesh splenorrhapy over injured portions of the spleen.

17
Q

In a patient with an aortic injury and an associated splenic injury, what is the operative approach?

A

First, splenectomy, then address the more complicated issue.