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 abdomen shot  
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Author13 Posts
  #1

A young man is shot with a .45 caliber revolver, point blank in the lower abdomen, just above the pubis. The entrance wound is at the midline, and there is no exit wound. X-ray films show the bullet embedded in the sacral promontory, to the right of the midline. Digital rectal examination and proctoscopic examination are negative, but he has gross hematuria. He is hemodynamically stable. Which of the following is the most appropriate next step in management?
A. CT scan of the abdomen
B. Intravenous pyelogram
C. Retrograde cystogram
D. Diagnostic peritoneal lavage
E. Exploratory laparotomy




  #2

I think it's E :?:


  #3

Exploratory LAP


  #4

correct, answer is E.


  #5

i think its e as well.

but the "hemodynamically stable did throw me off...to think it would be a.



  #6

any gun shot to the abdomen must do laparoscopic /laparotomy exploration but since the pacient is stable..i would go for a cystogram
the Q asks about the best next step..so ill go for E


  #7

E nod


  #8

WHY NOT IV PYELOGRAM?


  #9

hi KMGsmiling face
COZ IT IS A GUNSHOT IN THE ABDOMIN ACORDING 2 CARLOS NOTE NEED EXPOLATORY LAPAROTOMY


  #10

A.................. CT as he is hemodynamically stable


  #11

E


  #12

My answer would be A. Patient is hemodynamically stable, we have time to evaluate the patient. And it does not necessarily mean that we need to remove the bullet always.. and surgical attempts to remove this bullet sometimes cause more harm that good.

http://www.trauma.org/index.php/main/article/601/

Indications for bullet removal

1.

Just under the skin, and residing in a pressure area where the bullet is painful when the patient sits or lies down.
2.

Visibly bulging beneath the skin and causing cosmetic distress.
3.

In a joint space
4.

In the globe of the eye.
5.

In a vessel lumen causing ischaemia or with the risk of embolisation to the heart, lungs or peripheral vessles.
6.

Impinging on a nerve or nerve root and causing pain.
7.

Localised abscess formation (usually due to dirt or clothing fragments entrained by the bullet).
8.

Required for forensic investigation and the patient and surgeon are in full agreement that the removal will not result in increased pain, suffering, complications or injury and both agree to the removal.
9.

Documented elevated lead levels, usually in a child and occurring several months after injury (extremely rare)



  #13

all gun shots eventually go to OR but if you're hemodynamically stable--you get an abd CT first... if you're hemodynamically unstable then OR without abd CT.

since hes hemodynamically stable = Abd CT.





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