Abd Trauma - Cindy Kin 4.18.58 PM

Abd Trauma - Cindy Kin 4.18.58 PM - Abdominal Trauma...

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Unformatted text preview: Abdominal Trauma Abdominal Trauma Cindy Kin Trauma Conference 8 January 2007 Stanford General Surgery Blunt Abdominal Trauma Blunt Abdominal Trauma Mechanisms Direct impact Acceleration-deceleration forces Shearing forces No correlation between size of contact area and resultant injuries. Abdomen = potential site of major blood loss. Initial Evaluation and Treatment Initial Evaluation and Treatment Is there a surgical intraabdominal injury? PE: guarding, peritoneal signs, tenderness, nausea. DRE. Lower rib fxs: 10-20% a/w spleen/liver injury Seatbelt sign a/w intestinal injury and mesenteric tears. Direct blunt trauma: rupture/tear of solid organs. Flank pain or contusion often late signs of retroperitoneal bleed Rapid resuscitation CXR, Pelvic X-ray FAST v DPL v CT Labs: Hct, WBC, amylase, UA, ABG, T+C Blunt Abdominal Trauma Blunt Abdominal Trauma INDICATIONS for CT Blunt trauma with closed head injury Blunt trauma with spinal cord injury Gross hematuria Pelvic fx, +/- suspected bleeding Pt requiring serial exams, but will be lost to PE for prolonged period (ie orthopedic procedures, general anesthesia) Pts with dulled or altered sensorium CONTRAINDICATIONS: unstable patients Blunt Abdominal Trauma Blunt Abdominal Trauma CT FAST DPL Accuracy 96% 95-99% 95% Sensitivity 97% 90-92% 100% Specificity 95% 88-90% 85% Drawbacks Stable pts only Cannot evaluate retroperitoneum. Cannot identify source of fluid. 0.5% miss intestinal perforation; cannot distinguish blood v bowel contents Blunt Abdominal Trauma Blunt Abdominal Trauma Shock with expanding abdomen, pnemoperitoneum, retroperitoneal air INDICATIONS FOR LAPAROTOMY Imaging: CXR FAST/DPL/CT Stable w/ peritoneal signs Peritoneal signs, HD unstable, sepsis + equivocal Observe, +/- re-image Blunt Abdominal Trauma Blunt Abdominal Trauma ROLE OF DIAGNOSTIC LAPAROSCOPY Hemodynamically stable patients Inadequate/equivocal FAST or borderline DPL (80K-120K RBC/HPF) Intermittent mild hypotension or persistent tachycardia Persistent abdominal signs/symptoms Potential to decrease # of nontherapeutic laparotomies Blunt Abdominal Trauma Blunt Abdominal Trauma PREDICTIVE VALUE OF QUANTIFYING BLOOD VOLUME ON FAST EXAM Hemoperitoneum score on ultrasound a better predictor of need for therapeutic laparotomy than admission blood pressure and/or base deficit....
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Abd Trauma - Cindy Kin 4.18.58 PM - Abdominal Trauma...

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