Trauma - Abdominal Flashcards
4 compartments/cavities of abdomen
- anterior abdomen and thoraco-abdominal
- flank
- back/retroperitoneal
- pelvic
Peritonitis signs
- rigidity
- rebound pain: (push down on abdomen, pain worsens when pressure is released)
Kehr’s sign
- shoulder pain that worsens with inspiration
- indicates gall bladder or diaphragm irritation
Cullen’s sign
-bruising around umbilicus
Grey-Turner’s sign
- bruising on flank
- indicates retroperitoneal bleed
Abdominal Physical Exam
- external injury signs
- abdominal distension
- scars
- pelvic exam (one and done)
- rectal, perineal, vaginal exams
what is the gold standard for evaluation of the abdomen in the stable patient?
CT
Direct Peritoneal Lavage
- infuse saline into abdomen, drain saline, assess for blood
- fallen out of practice due to ultrasound and FAST exam
concern with abdominal retractors
-induce parasympathetic response
Exploratory Laparotomy - major concerns
- diaphragmatic tear: pneumothorax
- subcutaneous emphysema
- venous gas embolism
- decreased venous return
Exploratory Laparotomy - anesthesia considerations
- massive hemorrhage
- keep warm
- keep paralyzed
- decompress stomach
- decompress bladder
- treat hypotension with volume not pressors
Normal & Elevated Intraabdominal Pressures
- normal < 5 mmHg
- compartment syndrome > 20 mmHg
Abdominal Compartment Syndrome - anesthesia considerations
- fluid load prior to release
- vasopressors
- increased minute ventilation: combat acidosis
- electrolyte management: calcium to counteract hyperkalemia effects
Liver Lacerations
- low grade lacerations: watch and wait
- high grade lacerations: surgical, may involve cross clamping, massive transfusion
Spleen
- low grade: watch and wait
- high grade: surgery vs splenectomy, pneumococcal vaccine (decreased immune status)
