Rigidity, spasm, or guarding o Penetrating trauma o Amylase levels o Nonoperative o Bowel rest o Percutaneous drainage o Small bowel injury o Compression can result in: Rupture Hematoma Tearing Chance fx o Assessment findings Seatbelt sign or bruising 33
Rebound tenderness Muscle spasm/rigidity/in epigastric area or LUQ o Large bowel injury o Mech: rupture, tear, or avulsion o Penetrating: less common o Assessment Peritoneal irritation Hypovolemic shock Evisceration of bowel o Definitive care Primary repair or diverting colostomy o Rectal injury o Mech: penetrating mech more common. Immediate signs of periotonsis common in anterior and lateral wall injuries o Assessment: Bleeding from and around rectum Scrotal hematoma, labia purple swollen o Definitive care Diverting colostomy o Gastric and esophageal injury o Assessment More common with penetrating injury Tenderness, guarding, or rigidity Blood from NG or OG tubes o Definitive care Surgical intervention o Genital trauma (male) o Contusion/rupture o Strangulation/amputation o Penetrating injuries o Definitive care: surgical repair, compression dressings 34
o Bladder and urethral injury o Intraperitoneal vs. extra peritoneal bladder rupture o Urethral trauma Less protected in males o Assessment: Urge to urinate Blood at uretral meatus Suprapubic tenderness or rebound pain High riding prostate o Definitive care: Extraperitoneal bladder injury Urinary catheter Intraperitoneal injury Surgical repair o Pelvic fracture o Patterns of injury o Stable Minimal or no displacement of pelvic ring o Unstable Two or more fx of the pelvic ring; outward rotational displacement Hemorrhage risk o Assessment External rotation Blood at the meatus!!!! Pelvic instability Hypovolemic shock o Definitive care Hemorrhage control Stabilize pelvis Binder/sheet/fixator o Renal injury 35
o Grades I to V o High index of suspicion Blunt flank trauma Deceleration injuries Falls from heights Penetrating trauma to the flank or pelvis o Reevaluation adjuncts Labs Coagulation studies Serum amylase- liver Urine pregnancy test Gastric contents Imaging studies Radiographs CT cystogram Urethrogram Angiography Solid organ injury Stable Risk or contrast reaction Embolization o FAST (focused assessment with sonography for trauma) o Portable ultrasound o Excellent sensitivity to blood, but not definitive factor If theres not o Advantages No ionizing radiation Noninvasive o Limitations Not as sensitive with smaller volumes of blood Serial examinations may be required Will not identify retroperitoneal o CT 36
o Diagnostic tool in STABLE trauma o Used to detect Hemoperitoneum Hollow viscus injuries or free air o Not indicated in the hemodynamically unstable o Peritoneal lavage o For hemodynamically unstable patients o Advantages
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