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In case of abdominal trauma what do you do in the following cases? Here is my summary... I hope it helps. (correct any that are wrong please!)
1. GSW to abdomen --- Exp. Lap
2. Stab wound to abdomen and clear signs of penetration to organs ---Exp lap
3. Shallow Stab wound which only penetrated skin and fat. ---digital exploration of the wound and observation
4. Blunt trauma and signs of internal bleeding, hemodynamically STABLE ---CT Scan (can ONLY be done if patient is STABLE)
5. Blunt trauma and hemodynamically UNSTABLE A) If no signs of peritoneal irritation ---DPL i) if DPL Negative ---Observe ii) if DPL Positive --- Exp. Lap
B) If signs of peritoneal irritation ---Exp Lap (even if stable)
___________________ Our greatest glory is not in never falling, but in rising every time we fall.
DrVirgo Forum Hero
Topics: 1096 Posts: 3,515
06/22/07 - 09:16 AM
#2
Come on people! This is really important stuff to know... I would like to get your input on it... so am i right or am i right? please confirm or correct or add your ideas!!! ___________________ Our greatest glory is not in never falling, but in rising every time we fall.
sprint123 Forum Guru
Topics: 129 Posts: 870
07/02/07 - 06:02 PM
#3
I think you have covered the maangement well Dr.Virgo!
I would like to add that We should do exploratory laparatomy for injuries with Protruding Viscera also!
khorshid Forum Guru
Topics: 32 Posts: 592
07/05/07 - 05:40 AM
#4
You're right DR.Virgo, just in unstable with no peritoneal signs sono can be done too
cirus Forum Guru
Topics: 108 Posts: 740
07/07/07 - 06:25 AM
#5
Blunt trauma and hemodynamically UNSTABLE A) If no signs of peritoneal irritation ---DPL
shouldn't we have an U/S 1st to see if there is a fluid collection or not before DPL
the most comman cause of fluid with no periont irrit is spleen inj (as it may be to few to cause irrit, but still a medical emergency that has to be investigated for fear of splenic destruct & necrosis). esp if trauma to left side, if trauma to right side, may be liver.
If there is retroperitoneal air, then suspect duedenal inj
oggn Forum Elite
Topics: 52 Posts: 169
07/07/07 - 11:54 AM
#6
Blunt trauma and hemodynamically UNSTABLE If no signs of peritoneal irritation-USG,--procede acc.Now a days no rle of DPL.
cirus Forum Guru
Topics: 108 Posts: 740
07/09/07 - 02:13 PM
#7
well i agree with u but apparently the boards don't..
Their explanation is that US may miss blood or fluid if its a small amount, so DPL should always be done if hemodynamically stable, but the dilemma im in is that UW q ans was DPL as the next step & not US ???
lena02 Forum Newbie
Topics: 3 Posts: 27
07/21/07 - 04:00 AM
#8
i read the following considering blunt trauma to the abdomen:
if pt is stable observe the patient and consider contrast CT
if pt is hemodynamically unstable and doesnt respond to fluid challenge its then laparatomy
if pt is hemodynamically unstable and there is an obvious source of blood loss opt to iv contrast abdomen and pelvic ct scan and never do dpl coz it can alter the scan results..
after all i have read in the post im confused
lena02 Forum Newbie
Topics: 3 Posts: 27
07/21/07 - 05:36 AM
#9
i reviewed it and changed my answer its dpl
DrVirgo Forum Hero
Topics: 1096 Posts: 3,515
08/01/07 - 11:57 AM
#10
Good case:
Attached Files: AbdomTrauma (Small).JPG (42 KB, 50 downloads) ___________________ Our greatest glory is not in never falling, but in rising every time we fall.
DrVirgo Forum Hero
Topics: 1096 Posts: 3,515
08/01/07 - 12:02 PM
#11
And another good one:
Attached Files: AbdomTrauma2 (Small).JPG (42 KB, 35 downloads) ___________________ Our greatest glory is not in never falling, but in rising every time we fall.
DrVirgo Forum Hero
Topics: 1096 Posts: 3,515
08/01/07 - 06:30 PM
#12
-Just trying to get these questions in one place so I can compare them later. GSW to Abdomen
Attached Files: AbdomTrauma3 (Small).JPG (36 KB, 23 downloads) ___________________ Our greatest glory is not in never falling, but in rising every time we fall.
cirus Forum Guru
Topics: 108 Posts: 740
08/14/07 - 02:46 AM
#13
The managment according to new qs from UW:
1st Hemodynamically unstable:
1st Step---->IV Fluids--->Still unstable
2nd--->FAST (Focused Assessment with Sonography for Trauma)
Still -ve---> 4th step(By this intra-peritoneal Bleeding is excluded, So search for extra-peritoneal, esp if there is fracture pelvis)
Angiogram--->Diagnostic & Therapeutic
If pt stabilizes after fluids(1st step), then the next step would be a CT with contrast to identify organ injury..
If after fluids p has abdominal pain + REBOUND (i.e peritoneal signs-->Exploratory Laparotomy directly)
Hope that helps
cirus Forum Guru
Topics: 108 Posts: 740
08/14/07 - 02:52 AM
#14
So i also guess that for pelvic from the start, its angiogram if unstable, while if stable, it will be external fixation..
DrVirgo Forum Hero
Topics: 1096 Posts: 3,515
10/27/07 - 02:22 PM
#15
Ok, for Blunt Trauma and Stable with NO signs of Peritoneal irritation --> Do CT
How about if: Blunt trauma, stable, but WITH signs of Peritoneal Irritation? Whats the next step? A. CT B. DPL C. U/S D. Exp Lap E. Fluids F. Something else
___________________ Our greatest glory is not in never falling, but in rising every time we fall.
MAGY17 Forum Elite
Topics: 30 Posts: 234
10/28/07 - 06:18 PM
#16
E -fluid
abc always first
DrVirgo Forum Hero
Topics: 1096 Posts: 3,515
10/28/07 - 07:10 PM
#17
Ok, and next step after fluids?
___________________ Our greatest glory is not in never falling, but in rising every time we fall.
please confirm or correct or add your ideas!!!
i reviewed it and changed my answer its dpl
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