Trauma – Abdomen

Question 0

Patient with stab wound. Management?

Answer 0

#Digital exploration of the wound
#If penetration into viscera for hemodynamic instability – exploratory laparotomy
#Otherwise observation

Question 1

Gunshot wound to abdomen classified as? Management? Exception?

Answer 1

Entrance or exit wound below the nipple line

Exploratory laparotomy for repair

Right upper quadrant – conservative treatment may be used if patient is monitored with serial abdominal CT scans

Question 2

Blunt trauma to the abdomen – management?

Answer 2

Determine whether there are internal injuries, bleeding #exploratory laparotomy or if signs of every peritoneal irritation (acute abdomen)

Question 3

Only places in the body 1500 mL of blood could “hide” without physical exam findings?

Answer 3

1. Thigh (Femur)
2. Abdomen
3. Pelvis

Question 4

How to diagnose intra-abdominal bleeding? (Relevant contraindication?)

If contraindicated, diagnosed with?

Answer 4

CT – must be hemodynamically stable

1. Peritoneal lavage
2. FAST scan (if positive, exploratory laparotomy)

Question 5

Most common source of significant intra-abdominal bleeding in blunt trauma?

Most common source in patients with insignificant or significant bleeding?

Answer 5

Spleen

Liver

Question 6

Patient with multiple trauma develops intraoperative coagulopathy – management?

If coagulopathy develops in hypothermic, acidotic patient?

Answer 6

Platelets and fresh frozen plasma

Terminate laparotomy – pack bleeding surfaces and temporarily close

Question 7

Abdominal compartment syndrome? Presents with? Management?

Answer 7

Significant fluid/blood given course of laparotomies result in swollen tissues and an abdominal wall that cannot be closed.

Distention, hypoxia secondary to inability to breathe, renal failure from pressure on vena cava,
Temporary cover (mesh or non-absorbable plastic) placed over abdominal contents