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    Chapter 5, Abdominal Trauma

    Uploaded by

    Randy Harris
    This document discusses the evaluation and management of abdominal trauma. It begins by outlining the objectives of identifying anatomic features, describing injury patterns from blunt and penetrating mechanisms, and evaluating patients with suspected abdominal injuries. It then provides details on assessing patients with abdominal trauma through history, physical exam, and diagnostic imaging. Indications for surgery are outlined as well as management of specific injury types such as gunshot wounds and pelvic fractures. The key points are that abdominal trauma is a common cause of preventable death if injuries are missed, the mechanism of injury determines likely organ injuries, and repeated exams and a low threshold for surgery are important.

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    Chapter 5, Abdominal Trauma

    Uploaded by

    Randy Harris
    103 views41 pages
    This document discusses the evaluation and management of abdominal trauma. It begins by outlining the objectives of identifying anatomic features, describing injury patterns from blunt and penetrating mechanisms, and evaluating patients with suspected abdominal injuries. It then provides details on assessing patients with abdominal trauma through history, physical exam, and diagnostic imaging. Indications for surgery are outlined as well as management of specific injury types such as gunshot wounds and pelvic fractures. The key points are that abdominal trauma is a common cause of preventable death if injuries are missed, the mechanism of injury determines likely organ injuries, and repeated exams and a low threshold for surgery are important.

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    This document discusses the evaluation and management of abdominal trauma. It begins by outlining the objectives of identifying anatomic features, describing injury patterns from blunt and penetrating mechanisms, and evaluating patients with suspected abdominal injuries. It then provides details on assessing patients with abdominal trauma through history, physical exam, and diagnostic imaging. Indications for surgery are outlined as well as management of specific injury types such as gunshot wounds and pelvic fractures. The key points are that abdominal trauma is a common cause of preventable death if injuries are missed, the mechanism of injury determines likely organ injuries, and repeated exams and a low threshold for surgery are important.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    103 views41 pages

    Chapter 5, Abdominal Trauma

    Uploaded by

    Randy Harris
    This document discusses the evaluation and management of abdominal trauma. It begins by outlining the objectives of identifying anatomic features, describing injury patterns from blunt and penetrating mechanisms, and evaluating patients with suspected abdominal injuries. It then provides details on assessing patients with abdominal trauma through history, physical exam, and diagnostic imaging. Indications for surgery are outlined as well as management of specific injury types such as gunshot wounds and pelvic fractures. The key points are that abdominal trauma is a common cause of preventable death if injuries are missed, the mechanism of injury determines likely organ injuries, and repeated exams and a low threshold for surgery are important.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 41

    Objectives

    Identify key anatomic features of the


    abdomen.
    Describe blunt and penetrating injury
    patterns.
    Describe the evaluation of the patient with
    suspected abdominal injury.

    Objectives
    Objectives
    times new Roman 42, bold, shadow
    Identify
    and apply
    the most appropriate
    diagnostic and therapeutic procedures.
    Huruf acutetimes
    new Roman 32, bold,
    shadow
    Discuss
    management
    of pelvic
    fracture.

    Key Questions
    What priority is abdominal trauma in the
    management of the multiply injured
    patient?
    Why is the mechanism of injury important?
    How do I know if shock is the result of an
    intraabdominal injury?

    Key Questions
    How do I determine if there is an
    abdominal injury?
    Who warrants a celiotomy (laparotomy?)
    How do I manage patients with pelvic
    fractures?

    External Anatomy

    Lower peritoneal
    cavity

    Pelvic cavity

    Abdominal Trauma
    What is one of the leading cause of
    preventable mortality?

    Unrecognized
    intraabdominal
    injury

    Abdominal trauma priority?


    Head and abdominal trauma?
    Head, chest, and abdominal trauma?
    Head, chest, abdominal and extremity
    trauma?
    Head, chest, abdomen, extremity, and
    pelvic trauma?

    Mechanism of Injury
    Why is it important to know?

    It determines what
    organs are probably
    injured.

    Blunt Force Mechanism


    How does it injure?
    Compression
    Crushing
    Shearing
    Deceleration (fixed organs)

    Blunt Force Mechanism


    What organs are commonly injured?
    Spleen
    Liver
    Small bowel

    Penetrating Mechanism?
    How does it injuries?
    Stab
    Low energy
    Lacerations
    Gunshot
    High energy

    Transfer of
    kinetic energy
    Cavitation
    Tumble
    Fragments

    Penetrating Mechanism
    Common injuries?
    Low Energy

    Liver
    Small bowel
    Diaphragm
    Colon

    High Energy

    Small bowel
    Colon
    Liver
    Vascular structures

    Assessment: History
    Blunt
    Speed
    Point of impact
    Intrusion
    Safety devices
    Position
    Ejection

    Penetrating
    Weapon
    Distance
    Number of wounds

    Assessment: Physical Exam


    Inspection
    Auscultation
    Percussion
    Palpation

    Abdominal Trauma
    What can compromise the exam?
    Alcohol or other drugs
    Injuries to brain, spinal cord
    Injury to ribs, spine, pelvis

    Assessment: Stab Wound


    How do I evaluate and manage the
    abdomen of a patient with an anterior
    abdominal, lower chest, flank, or back
    stab wound?
    What is a positive local wound
    exploration performed by a surgeon?

    Assessment: Penetrating Injury


    How do I evaluate and manage perineal,
    rectal, vagina, or gluteal penetrating
    injuries?

    Assessment: Gunshot Wound


    How do I evaluate and manage the
    abdomen of a patient with a possible
    abdominal GSW?
    Tangential?
    Exit wound?
    Likely injuries?

    X-rays?
    Lab
    determinations?

    Management: Gunshot Wound

    Early operation usually is


    the best strategy..

    Abdominal injury causes shock?


    Evidence of abdominal injury by
    mechanism, history, or evaluation
    Hypotension
    Positive FAST or grossly positive DPL
    Absence of massive hemothorax on
    chest x-ray

    Adjunct: Gastric Tube


    Relieves distention
    Decompresses stomach before DPL

    Basilar skull / facial fractures


    May induce vomiting /
    aspiration

    Adjunct: Urinary Catheter


    Monitors urinary output
    Decompress bladder before DPL
    Diagnostic

    Adjuncts: Blood / Urine Tests


    No mandatory blood tests
    Injury Severity and likely injuries
    Hemodynamically abnormal: type &
    crossmatch
    Pregnancy testing
    Alcohol or other drug testing
    Gross hematuria vs microscopic

    Adjuncts: X-ray Studies


    Routine
    Blunt: AP Chest and Pelvis
    Penetrating: AP chest and abdomen
    with markers (if hemodinamically
    normal)

    Adjuncts: Contrast Studies


    Urethrogram
    Cystogram
    IVP
    GI
    Abdominal CT

    Diagnostic Studies: Penetrating


    Lower chest wounds: Serial exams,
    thoracoscopy, laparoscopy, or CT scan
    Anterior abdominal stab wounds:
    wound exploration, DPL, or serial
    exams
    Back and flank stab wound: DPL,
    serial exams, or double- or triple
    contrast CT scan

    Indication for celiotomy?


    Blunt Trauma
    BP, suspect visceral injury
    Free air
    Diaphragmatic rupture
    Peritonitis
    + DPL, FAST, or contrast CT

    Indications for celiotomy?


    Penetrating Trauma
    Hypotension
    Peritoneal / retroperitoneal injury
    Peritonitis
    Evisceration
    + DPL, FAST, or contrast CT

    Remember

    a missed abdominal
    injury is a common
    cause of a potentially
    preventable death.

    Pelvic Fractures
    Mechanism
    AP compression
    Lateral
    compression
    Vertical shear

    Pelvic Fractures
    Classification
    Open
    Closed

    Pelvic Fractures
    Significant force
    applied
    Associated
    injuries
    Pelvic bleeding
    Bone ends
    Pelvic muscles

    Veins / arteries

    Pelvic Fractures
    Assessment
    Inspection
    Palpate prostate
    Pelvic ring
    Leg-length discrepancy, external rotation
    Pain on palpation of bony pelvic ring

    Pelvic Fractures
    Emergency Management
    Fluid resuscitation
    Determine if open or closed fracture
    Determine associated perineal / GU injuries
    Determine need for transfer
    Splint pelvic fracture

    ABCDEs and early surgical consultation


    Evaluation and management vary with a
    mechanism and physiologic response
    Repeated exams and diagnostic studies
    High index of suspicion
    Early recognition / prompt celiotomy

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