maria.b
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unstable patient with blunt abdominal injury,what do u do?
1.exploratory lap
2.DPL
also what r the indications for e.lap?
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| drkpp
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1. e.p
sorry am not sure of indications i base my decision on instinct
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| chemamr
Moderator and PGY2
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i go with 1, too.
Letīs operate the patient! 
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| maria.b
Forum Senior
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ok here's wat i know from what i have learned from UW and kaplan.....
just want to make sure that wat i have concluded is right
E.LAP
u do it..
1.all gun shot injuries
2.stab wounds when ther is obvious evisceration
3.all patients presenting with sign of peritonitis(guarding and rebound tenderness)
A COUPLE OF EXCEPTIONS TO PERITONITIS WOULD BE:
pancreatitis,diverticulitis and spontaneous bacterial peritonitis
ok...then coming to DPL...done in blunt trauma where u suspect a bleed
u do DPL basically in an unstable patient in ER setting to see if they have intraperitoneal bleed and then take them in for e.lap
if the same patient was stable do a CT to rule out a bld in the peritoneum
the third scenario.....splenic bleed... would be with a blunt abdominal trauma too
u have a bleeding patient when picked up by parademics...unstable given fluids..is pretty much stable now at the hospital so u do an US int he ER and find fluid in the spleno renal angle u do a CT...and based on the finding manage the patient best approach being not wanting to remove the spleen,but then too if bleeding too much its better to save the patient.
in the same aptient if he shows up not responding to iv fluids.i.e still unstable when he comes to ER they say take him in for an e-lap.There is no mention of DPL( UW q id 2229)
so how r we supposed to know if a blunt injury is splenic trauma?cuz like i said before in an accident question a patient presents with b.p:70/0 and yet is made to go thru DPL before e.lap(UW qid 1275)
so y not DPL in splenic trauma too........i am a little confused
anyone knows the right protocol?
thanks.
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| drkpp
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first of all not all gun shot wouns need ep. lap. take this: a gunshot wound with entry wound from the lateral thigh to exit wound pos. lat. no need of ep. lap.
any blunt trauma patient with low b.p iv. fluids and if responds more investigations are done basically to plan a careful surgery if necessary. if not stabilising with fluids then do we have a choice???? take him straight to e.r.
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| maria.b
Forum Senior
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abt gun shot wounds i meant abdominal gun shot wounds
then as far as unstable pts r concerned...just want to make sure we that we do DPL before e-lap.
thnks for the reply
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| drkpp
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dpl am not sure if its even done this days... sorry havent come across any question that refers to dpl as of now...
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| alenka
Forum Elite
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in kaplan surgery notes:
-UNSTABLE patients with BLUNT trauma-get DPL or ultrasound
-STABLE patients with BLUNT trauma to abdomen go for CT.
but how do you categorize the patient with blunt trauma who is hemodinamically stable but with signs and symptoms of acute abdomen?and what to do?
help......
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| maria.b
Forum Senior
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like i said as far as i know
peritonitis...stble or unstable..is indication enough for e.lap
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| phuluong2k
Forum Fanatic
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Same idea as alenka's
First: Do DPL in the Operation room or emergency room, alnernative ultrasound
Second: If DPL or USG is positve, do exploratory lap.
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| adeelmd
Forum Elite
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i agree.... in the kaplan lecture, they told us that dpl is not done anymore... and emergency ct would be the right answer if there. Since there is controversy, i doubt they would put both answers..... but i think the main problem is that you need to know where the lesion is before you explore the abdomen... correct?
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