TRAUMATIC ABDOMINAL INJURIES

Question 1

Peritoneal cavity – “true abdomen” contains what organs?

Answer 1

1) Solid organs
2) Portions of the large intestine
3) Most of the small intestines
4) Female reproductive organs

Question 2

Retroperitoneal space contains what organs?

Answer 2

1) Kidneys
2) Ureters
3) Inferior vena cava
4) Aorta
5) Pancreas
6) Much of the duodenum
7) Ascending descending colon and rectum

Question 3

GSW most commonly injure:
1) Small bowel (__%)
2) Colon (__%)
3) Liver (__%)
4) Abdominal vessels (___%)

Answer 3

1) 50
2) 40
3) 30
4) 25

Question 4

___% of GSW will require surgery for definitive intervention vs 15% of stab wounds

Answer 4

85

Question 5

Injuries most often involved in blunt abdominal trauma include:
a) ______ 40-55%
b) _____35-45%
c) ______ 5-10%

Answer 5

a) Spleen 40-55%
b) Liver 35-45%
c) Small bowel 5-10%

Question 6

What type of shock?
marked tachypnea

Answer 6

Severe hemorrhagic shock

Question 7

What type of shock?
Mild compensated shock

Answer 7

mild increase in ventilatory rate

Question 8

the most reliable indicator of intra-abdominal bleeding is the presence of what?

Answer 8

hypovolemic shock from an unexplained source

Question 9

Secondary assessment:

Answer 9

(a) Examine abdomen, flank and back
(b) Palpate for tenderness
(c) Auscultation
(d) Percussion

Question 10

Palpation
_______ historically thought to be a strong indicator of peritonitis.

Answer 10

Rebound tenderness

Question 11

Deep or aggressive palpation should be avoided if an obviously injured abdomen why?

Answer 11

in order to avoid dislodging clots or restarting hemorrhage, may also spill intra-abdominal contents.

Question 12

Significant tenderness to percussion or pain with coughing is a strong indicator for _____

Answer 12

Peritonitis

Question 13

What is the definitive treatment for patients that have sustained abdominal injuries?

Answer 13

Surgical intervention

Question 14

In Emergency Departments, STP’s, FRSS’s and many operation platforms _______ exams have become primary bedside modality to assess for intra-abdominal injury

Answer 14

FAST

Question 15

Details of FAST
What are the image acquisition sites?

Answer 15

RUQ, LUQ, pelvic, pericardial

Question 16

FAST:
Rotate the probe slightly counterclockwise in the RUQ or clockwise in the LUQ to align with the ribs and eliminate _____

Answer 16

rib shadow

Question 17

________ can help with the subxiphoid view

Answer 17

Bending the knees

Question 18

The ____ cardiac view is a secondary cardiac option if unable to get the subxiphoid view

Answer 18

PSLA

Question 19

What type of probe is used for FAST

Answer 19

curvilinear or phased-array

Question 20

Scan Planes:
1)RUQ and LUQ – ______
2)Pelvic – ________
3)Cardiac – _________

Answer 20

1) RUQ and LUQ – sagittal
2) Pelvic – transverse and sagittal
3) Cardiac – subxiphoid or PSLA

Question 21

FAST:
In the RUQ, visualize what 4 areas

Answer 21

Morison’s Pouch,
inferior tip of the liver,
R hemithorax,
sub diaphragmatic space

Question 22

FAST:
the LUQ, visualize what 4 areas

Answer 22

Splenorenal recess,
inferior tip of the spleen,
L hemithorax,
sub diaphragmatic space

Question 23

Target goal in the absence of TBI is systolic of ______mmHg. In TBI systolic minimum is ___mmHg

Answer 23

w/o TBI: 80-90
W/ TBI: 90

Question 24

Treatment for Eviscerated bowel

Answer 24

1) Do not attempt to replace the protruding contents
2) Viscera should be left in place
3) Clean or sterile dressing moistened with saline
4) Initial dressing may be covered with large, dry dressing to keep warm
5) Psychological support, keep patient calm. Any action that increases intra- abdominal pressure can cause more contents to protrude.

Question 25

True/False
You can send ABD trauma pt needing surgery to STP’s if there is a role 2 in the med plan

Answer 25

FALSE
Send to facility with surg capability

Question 26

Injuries to kidney, ureters, bladder most often present with _______
This will hot be noted unless what?

Answer 26

Hematuria
unless a urinary catheter is placed

Question 27

Treatment for ABD trauma
Aggressive fluid resuscitation may result in what?

Answer 27

coagulopathy and disrupt any clot formation.

Question 28

________ trauma should be suspected especially in straddle injuries and ejection from MVA/MCC as well as sexual assault

Answer 28

External genitala

Question 29

True/False
You should pack the vagina or urethra with suspected genital trauma

Answer 29

FALSE

Question 30

_______ fractures may result in large volume hemorrhage, may be associated with bladder lacerations, and injury to the walls of the vagina and rectum

Answer 30

Pelvic