Trauma 3 Abdomen Flashcards
What abdominal organ is most frequently injured by blunt trauma?
Spleen. Then liver
What are the three diaphragmatic openings?
T8: IVC
T10: esophagus
T12: aorta
I 8 10 eggs after 12
What abdominal organs are retroperitoneal?
Proximal duodenum, pancreas, kidneys, ureters, ascending and descending colon, abdominal aorta, IVC, renal and splenic vessels
Abdominal peritoneal organs
Liver, spleen, stomach, small bowel minus the proximal duodenum, sigmoid and transverse colon
Cullen’s sign indicates what type of bleed
Intraperitoneal
Grey Turners sign indicates what type of bleed?
Retroperitoneal
Kehr’s sign
Left should or neck pain due to splenic rupture, due to diaphragm irritation
Criteria for positive diagnostic peritoneal lavage
> 10 ml of blood on initial aspiration, > 100,000 RBCs, > 500 WBCs, Gram stain with bacteria or vegetable matter, amylase > 20 IU/L, presence of bile. Positive DPL means to OR for ex lap
What abdominal organ is most frequently injured by penetrating trauma?
Liver
Blood supply to liver
75% portal vein, 25% hepatic artery
Management of liver injury
Penetrating traumas will generally require operative management. Blunt trauma might be able to be observed depending on extent.
Pringle maneuver
Occlusion of portal triad during liver surgery. Max time is 20 min. If still bleeding despite this, consider possible injury to retro hepatic IVC
Best test to assess splenic injury
CT scan
How to determine viability of bowel in the OR.
Inject fluorescin dye IV. Use Woods lamp to inspect the bowel. Non viable bowel will appear patchy or no fluorescence.
Duodenal hematoma
From MVC. Also associated with child abuse. Presents with signs of SBO, need CT/ upper GI series to dx. Tx is non operative and includes NGT decompression, TPN, and re evaluate with upper GI series in one week.
Rectal injury features
Majority are caused by gun shot wound. 1/3 have associated bladder injury. Treatment is colostomy, which can be closed in 3-4 months.
Wirsung duct
Main duct of pancreas. Traverses length of gland and joins common bile duct.
Santorini duct
Accessory duct of pancreas. Branch from the main duct that has its own entry to the CBD
How much pancreas can be resected without causing endocrine or exocrine dysfunction?
80%
Four zones of retroperitoneum vascular structures
Zone 1: middle- aorta, proximal SMA, proximal renal artery, SMV, IVC. zone 2: upper lateral- renal artery and vein.
Zone 3: pelvic- iliac arteries and veins
Zone 4: portal-retrohepatic- portal vein, hepatic artery, IVC
Outcomes of abdominal vascular injury
High mortality. Can have vasculoenteric fistula complication
What test should be performed on a patient with suspected urethral disruption BEFORE foley placement?
Retrograde urethrogram (KUB)
What is a renal fracture?
Shattered kidney. Complete separation of renal parenchyma from collecting system, usually causing uncontrolled hemorrhage and requiring surgery.
What is the narrowest part of the CHILD’s airway?
Below the vocal cord, at the level of the cricoid. Therefore ETT size is based on the size of the cricoid ring rather than the glottic opening
Equation for ETT size for children
ETT size = (age + 16) / 4
What’s a trick for remembering what the systolic BP should be for a child?
Systolic BP = 80 + 2* age in years
Pediatric GCS
Insert table here
What is adequate urine output for an infant? For a child? For an adolescent?
Infant 2 cc/kg/hr
Child 1.5 cc/kg/hr
Adolescent 1 cc/kg/hr
