TRAUMATIC ABDOMINAL INJURIES Flashcards
Peritoneal cavity – “true abdomen” contains what organs?
1) Solid organs
2) Portions of the large intestine
3) Most of the small intestines
4) Female reproductive organs
Retroperitoneal space contains what organs?
1) Kidneys
2) Ureters
3) Inferior vena cava
4) Aorta
5) Pancreas
6) Much of the duodenum
7) Ascending descending colon and rectum
GSW most commonly injure:
1) Small bowel (__%)
2) Colon (__%)
3) Liver (__%)
4) Abdominal vessels (___%)
1) 50
2) 40
3) 30
4) 25
___% of GSW will require surgery for definitive intervention vs 15% of stab wounds
85
Injuries most often involved in blunt abdominal trauma include:
a) ______ 40-55%
b) _____35-45%
c) ______ 5-10%
a) Spleen 40-55%
b) Liver 35-45%
c) Small bowel 5-10%
What type of shock?
marked tachypnea
Severe hemorrhagic shock
What type of shock?
Mild compensated shock
mild increase in ventilatory rate
the most reliable indicator of intra-abdominal bleeding is the presence of what?
hypovolemic shock from an unexplained source
Secondary assessment:
(a) Examine abdomen, flank and back
(b) Palpate for tenderness
(c) Auscultation
(d) Percussion
Palpation
_______ historically thought to be a strong indicator of peritonitis.
Rebound tenderness
Deep or aggressive palpation should be avoided if an obviously injured abdomen why?
in order to avoid dislodging clots or restarting hemorrhage, may also spill intra-abdominal contents.
Significant tenderness to percussion or pain with coughing is a strong indicator for _____
Peritonitis
What is the definitive treatment for patients that have sustained abdominal injuries?
Surgical intervention
In Emergency Departments, STP’s, FRSS’s and many operation platforms _______ exams have become primary bedside modality to assess for intra-abdominal injury
FAST
Details of FAST
What are the image acquisition sites?
RUQ, LUQ, pelvic, pericardial
FAST:
Rotate the probe slightly counterclockwise in the RUQ or clockwise in the LUQ to align with the ribs and eliminate _____
rib shadow
________ can help with the subxiphoid view
Bending the knees
The ____ cardiac view is a secondary cardiac option if unable to get the subxiphoid view
PSLA
What type of probe is used for FAST
curvilinear or phased-array
Scan Planes:
1)RUQ and LUQ – ______
2)Pelvic – ________
3)Cardiac – _________
1) RUQ and LUQ – sagittal
2) Pelvic – transverse and sagittal
3) Cardiac – subxiphoid or PSLA
FAST:
In the RUQ, visualize what 4 areas
Morison’s Pouch,
inferior tip of the liver,
R hemithorax,
sub diaphragmatic space
FAST:
the LUQ, visualize what 4 areas
Splenorenal recess,
inferior tip of the spleen,
L hemithorax,
sub diaphragmatic space
Target goal in the absence of TBI is systolic of ______mmHg. In TBI systolic minimum is ___mmHg
w/o TBI: 80-90
W/ TBI: 90
Treatment for Eviscerated bowel
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.
True/False
You can send ABD trauma pt needing surgery to STP’s if there is a role 2 in the med plan
FALSE
Send to facility with surg capability
Injuries to kidney, ureters, bladder most often present with _______
This will hot be noted unless what?
Hematuria
unless a urinary catheter is placed
Treatment for ABD trauma
Aggressive fluid resuscitation may result in what?
coagulopathy and disrupt any clot formation.
________ trauma should be suspected especially in straddle injuries and ejection from MVA/MCC as well as sexual assault
External genitala
True/False
You should pack the vagina or urethra with suspected genital trauma
FALSE
_______ fractures may result in large volume hemorrhage, may be associated with bladder lacerations, and injury to the walls of the vagina and rectum
Pelvic
