PenetratingAbdominalTrauma

PenetratingAbdominalTrauma - PenetratingAbdominalTrauma...

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    Penetrating Abdominal Trauma –  Always Operate?
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    Penetrating Abdominal Trauma Algorithm Laparotomy Hemodynamic Stability? Diffuse Abdominal Tenderness Yes No
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    Penetrating Abdominal Trauma Algorithm Left thoraco-abdominal injury? Other causes of hemodynamic lability  present? No Diffuse Abdominal Tenderness Hemodynamically Stable? Yes No
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    Penetrating Abdominal Trauma Algorithm Laparoscopy Stab wound – observe GSW – CT  and observe/operate No Diffuse Abdominal Tenderness Hemodynamically Stable Left thoraco-abdominal injury? Yes No
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    Penetrating Abdominal Trauma Algorithm DPA (Diagnostic Peritoneal Aspiration) Positive –  Laparotomy Negative – Continue workup  elsewhere Laparotomy No Diffuse Abdominal Tenderness Hemodynamically Labile Other causes of hemodynamic liability present? Yes No
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    Stab Wounds Hemodynamically stable, No diffuse abdominal tenderness SERIAL EXAMS Physical exam only 3% false negative. . 94% accuracy Better than CT, DPL, other studies Local wound exploration useless, no longer practiced Usually no other studies needed Consider CT for suspected liver or renal injuries Consider rigid sigmoidoscopy for rectal blood Laparoscopy generally not useful, some groups doing studies
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    Stab Wounds 651 patients knife wounds to anterior abdomen 345 (53%) acute abdomen sx -> immediate operation (5% unnecessary) 306 (47%) conservative management  including  patients with omental evisceration, free air, blood  on paracentesis, shock on admission (this group remains a bit controversial) 11 (3.6%) required subsequent operation -> no mortality Of 467 pts with peritoneal penetration,
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PenetratingAbdominalTrauma - PenetratingAbdominalTrauma...

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