Trauma Flashcards
management of hemodynamically unstable trauma patient with FAST positive
urgent laparotomy
management of hemodynamically stable trauma patient with Grade I-III (low grade) splenic injury
may observe as long as without any evidence for other intra-abdominal injuries, active contrast extravasation, or a blush on CT
management of splenic injury with contrast extravasation or vascular blush on CT
splenic artery embolization
management of high grade IV, V splenic injury
may consider embolization in grave IV, controversial
splenectomy for some IV, and V
absolute indications for laparotomy in blunt abdominal trauma
Anterior abdominal injury with hypotension
Abdominal wall disruption
Peritonitis
Free air under diaphragm on chest radiograph
Positive FAST or DPL in hemodynamically unstable patient
CT-diagnosed injury requiring surgery
absolute indications for laparotomy in penetrating abdominal injury
Injury to abdomen, back, and flank with hypotension
Abdominal tenderness
GI evisceration
High suspicion for transabdominal trajectory after gunshot wound
CT-diagnosed injury requiring surgery
relative indications for laparotomy in blunt abdominal injury
Positive FAST or DPL in hemodynamically stable patient
Solid visceral injury in stable patient
Hemoperitoneum on CT without clear source
relative indications for laparotomy in penetrating abdominal trauma
Positive local wound exploration after stab wound
signs and symptoms of gastric outlet obstruction develop (abdominal pain, distention, and vomiting) in patient with abdominal trauma suggestive of
duodenal hemorrhage
what side does diaphragmatic rupture usually happen on
left
management of hemodynamically stable patients with liver injury who demonstrate pooling of intravenous contrast on initial or subsequent abdominal CT scan
hepatic embolization
management of hemodynamically stable patients with liver injury with no other indication for abdominal exploration
observation
monitored care, serial abdominal examination, and serial hemoglobin assessment and potentially hepatic embolization
contraindications to non-operative management of liver injury
●Hemodynamic instability after initial resuscitation.
●Other indication for abdominal surgery (eg, peritonitis).
●Gunshot injury (relative contraindication if extrahepatic injury is suspected).
●Absence of an appropriate clinical environment to provide monitoring, serial clinical evaluation, or availability of facilities and personnel for hepatic embolization or urgent abdominal exploration should the need arise.
management of grade VI liver injury
hepatic avulsion - by nature are hemodynamically unstable and require operative management
indication for surgical management of liver injury
hemodynamically unstable patients
nonoperatively managed patients who continue to bleed (ongoing blood transfusion, hemodynamic instability), and in some patients who manifest a persistent systemic inflammatory response (ileus, fever, tachycardia, oliguria)
ipsilateral fixed and dilated pupil due to unopposed sympathetic tone, further herniation compresses pyramidal tract which results in contralateral motor paralysis - caused by which herniation syndrome
uncal herniation
