kpmle2
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A 22-year-old man is brought to the emergency department 20 minutes after he sustained a gunshot wound to the abdomen. On arrival, administration of oxygen by face mask and fluid resuscitation with 2 L of lactated Ringer's solution are begun. He is alert but unable to move his lower extremities. His temperature is 37.4°C (99.3°F), blood pressure is 140/80 mm Hg, pulse is 105/min, and respirations are 14/min. The pupils are equal and reactive to light. Examination shows no jugular venous distention. Breath sounds are equal bilaterally, and heart sounds are normal. There is a single gunshot wound to the left of the umbilicus that is not bleeding. No exit wound can be found. The abdomen is nondistended and soft, there is mild tenderness around the wound. Bowel sounds are normal. Rectal examination shows no sphincter tone. Sensation is absent below the L2 level. Test of the stool for occult blood is positive. Insertion of a nasogastric tube yields clear fluid, and insertion of a urinary catheter yields clear urine. A urine dipstick is negative for blood. X-ray films of the chest, abdomen (supine and decubitus), and pelvis show a small caliber bullet just to the right of the spine at L2. No other abnormalities are seen. Which of the following is the most appropriate next step in diagnosis?
O A) Ultrasonography of the abdomen
O B) CT scan of the abdomen
O C) Colonoscopy
O D) Diagnostic peritoneal lavage
O E) Arteriography
O F) Laparotomy
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| hanialkhadher
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F) Laparotomy
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| kpmle2
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yes laprotomy.
can u tell me when we do DPL. Thanks.
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| madoo
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i think we do DPL in suspected intraabdominal bleeding in unstable patient
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| kpmle2
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thanks madoo.
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| MAGY17
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uw .......unstable pcte with suspect intraabd. hem do foccus ass. u/s if u/s is inconclud them do DPL
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| hanialkhadher
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kpmle2 wrote:
yes laprotomy.
can u tell me when we do DPL. Thanks.
Do DPL in the unstable patient that you don't know if he has intra abdominal injury , and in the stable patient if you still suspect intra abdominal injury despite -ve CT or No avaliable CT.
NEVER DO DPL IF YOU WILL DO CELIOTOMY 
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"أقرأ بأسم ربك الذي خلق,خلق الأنسان من علق,أقرأ و ربك الأكرم, الذي علم بالقلم,علم الأنسان ما لم يعلم"
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| ing
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Is it for any gun shot in ab need to do laparotomy?
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| MAGY17
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GUNSHOT=LAPAROTOMY
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| funkdoc19
Forum Newbie
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dpl finds injury from spleen or diaphram, hardly used now...if one of the hard signs are present (implailment, peritonitis, evisceration, blood per rectumor ng, hd unstable)
see website for trauma http://www.nordictraumarad.com/Syllabus06/NordicP...
there doesnt seem to be a hard sign, so ex lap is a no go, the neuro signs is interesting, and dpl has too many falsly pos.
i'd go with ct scan to trace the course of the bullet, dpl is second choice, but steroids have to be given to penetrating trauma with cord injury
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| Miradautas Vras
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Every gushot below nipple level[4th rib]gets a laparotomy. DPL is done in a hemodynamically stable/unstable patient whose abdominal findings are suspicious and are not confirmed by FAST. Though If an option is given of doing a laprotomy in a severely hemodynamically unstable patient where FAST is done--> Pick it instead of DPL. I have seen it in couple of UW questions. When you are almost certain of abdominal organ rupture and distension DPL can be skipped directly for emergency laprotomy.
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