surgical emergencies and abdominal trauma Flashcards
what are the different mechanisms of trauma ?
blunt
penetrating
blast
burns
what is the trimodal peak of traumatic death ?
- first peak which is 50% covers immediate deaths lacerations of the brain stem and upper spinal cord lacerations
- second peak which is 30% covers deaths that occur within 2-3 hours also preventable deaths
- third peak which is 20% death after days or weak after injury
what are the causes os second peak mortality ?
CNS related- extradural and subdural hematomas
Chest related - haemothorax and pneumothorax
Significant blood losses
what are the phases of trauma care?
- access
- prehospital phase
- ER resuscitation
- operative phase
- postoperative phase
- rehabilative phase
what can abdominal injuries be broadly divided into ?
blunt
penetrating
what are the causes of blunt abdominal trauma ?
motor vehicle crashes
falls (vertical deceleration)
motorcycle + bicycle crashes
assault
what are the causes of penetrating abdominal trauma?
stab wounds
gunshot wounds
impalement injuries
what are the anatomical divisions of the abdomen ?
intrathoracic abdomen
true abdomen
retroperitoneal abdomen
pelvic abdomen
what is the best imaging modality for the retroperitoneal abdomen ?
CT in haemodynamically stable patients
what type of evaluation is needed for retroperitoneal abdomen ?
serum amylase
radiography and angiography
what kind of injury can be caused by a seatbelt ?
avulsion injury of the mesentry of the small bowel
which organ is most likely to be affected in blunt trauma?
spleen
which organ is less likely to be affected by blunt trauma ?
vascular , diaphragm
which organ is most likely to be affected by penetrating trauma ?
liver
which organ is least likely to be affected by penetrating trauma ?
diaphragm
what is the role of surgeon in trauma management ?
decrease preventable mortality
decrease morbidity
what are the 3Rs in respective management ?
resuscitation
review
repair
if the patient is haemodynamically unstable despite resuscitation with no evident cause whats the next step ?
laparotomy
what are the different types of intraperitoneal injuries ?
vascular
solid
hollow organ
a fracture to the ribs would cause an injury to what organs ?
the liver and the spleen
what would a fracture in the transverse process cause ?
ureteric injury
what is retroperitoneal stippling associated with?
duodenal injuries
what is a loss of the psoas shadow associated with ?
retroperitoneal haemorrhage
what could an opaque foreign body on imaging indicate?
the presence of bullets
why is it better to do a sitting abdominal X-ray than a supine abdomen X-ray?
to show :
diaphragmatic rupture
free air intraperitoneal
when is arteriography indicated ?
to diagnose renal artery thrombosis
what is the lethal triad of death in trauma patients ?
acidosis
hypothermia
coagulopathy
what are the indications for laparotomy ?
in penetrating injuries where the patient is :
haemodynamically unstable
evisceration
all gunshot wounds
anterior stab wounds with physical findings
back stabs and signs of peritonitis
if there is a back stab and no signs of peritonitis what is the next step ?
triple contrast CT
selective management
when is laparotomy indicated in blunt trauma patients ?
haemodynamically unstable patients with injury confined to abdomen
what is the next best step in management with patients who have multiple abdominal injuries ?
FAST in trauma centres
DPL otherwise
