drduck
Forum Guru
Topics: 82
Posts: 529
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i m cutting short the Q, but giving all the information,
middle age adult female, jumps from 2nd floor of her building, brought to the ER.
she is UNCONSCIOUS, bleeding from nose, pupils- normal, GCS- 10.
open left tibial #
what will be next best step.
-CT head
-X-ray left leg AP/lateral
-X-ray Spine
-Lumber Puncture
-X-ray head
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| drduck
Forum Guru
Topics: 82
Posts: 529
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Q seems to be very easy and as far as i m concern only 2 options seems to be near correct, bu which one be the first or next best step remains Q for me.
i m not telling the answer right now, but be open to share any doubts u came across solving this Q,
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| Ivonne
Forum Guru
Topics: 53
Posts: 1,404
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I got this Q wrong and picked A worried about a intracranial hemorrhage but found out that the answer is x-ray spine.
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If you beleive you can do it then you WILL DO IT!! (by Mymeghhi)
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| drduck
Forum Guru
Topics: 82
Posts: 529
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how is that we both making same mistakes every time??
is that UW always right??
i just came across a mistake by UW guys.
in case of blunt abdominal trauma, what is the protocol??
if BP doesnot stablise after 2L of crystalloid infusion.....do FAST, and if such facility not available go for diagnostic peritoneal lavage...if anyone comes positive then, go for laprotomy.
even if DPL comes negative, but BP still not maintained and strong suspition of haemorrage.......think of retroperitoneal origin.....do angiography....
another case discussed in UW says that in cases of strong suspision....if patient is haemodynamically unstable....possiblity of intraperitoneal and retroperitoneal bleed should be considered and urgent laprotomy indicated....even before doing DPL.
i got both of them wrong bcos i chose the other option everytime.
KAPLAN says totaly different stuff, any case of blunt trauma....with derranged haemodynamics....strong possibility for h'age...do urgent laprotomy...even if FAST or DPL comes negative??
which to follow??
plz help guys............
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| drduck
Forum Guru
Topics: 82
Posts: 529
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another thing i wanted to ask was, in case of penetrating abdominal wound, what is the rule??
UW says,
i mean if patient is having low BP--------->infuse 2L of crystalloid-------->BP maintained??-------->yes-------->observe
--------->no--------->do urgent laprotomy.
KAPLAN says,
any case of penetrating abd. wound------->do urgent laprotomy always??
again different opinions.....which one to follow??
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| Ivonne
Forum Guru
Topics: 53
Posts: 1,404
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As everything in medicine it depends...here a revision of emedicine:
- Stab wounds
- Unstable patients or those with clear-cut peritonitis should undergo exploratory laparotomy.
- If stable, patients may have local wound exploration to ascertain if the peritoneum was violated. If unable to perform or if flank or thoracoabdominal wounds are present, other methods must be used. DPL is still an option, but it is currently being used less frequently. A positive FAST examination result has a high positive predictive value for a therapeutic laparotomy, but a negative FAST examination result cannot be relied upon to rule out injury.
- If thoracoabdominal, a chest radiograph should be obtained. If no signs of diaphragmatic injury are present, laparoscopy is usually advocated; although some surgeons will elect not too perform this on a right-sided wound given the low likelihood of delayed complications.
- The use of CT scan is still controversial; some centers use it as a screening test in patients with anterior stab wounds, while others feel the cost-benefit ratio is not justified. A triple contrast CT should be performed on patients with penetrating flank wounds.
- Essentially all nonoperative patients, except those who have a wound that clearly does not penetrate the abdomen, should be observed for serial examinations. Literature is beginning to support a shortened time frame of 12 hours, but most centers use about 24 hours.
Gunshot wounds - All unstable gunshot wounds should proceed emergently to the operating room (OR). Abdominal and other radiographs (depending on possible bullet course and number of wounds) should be taken at some point during the patient's care to account for all bullets.
- In the past, all gunshot wounds that were clearly nontangential were taken to the OR for exploration. An increasing body of literature supports CT imaging, either triple contrast or just intravenous contrast alone to evaluate for intra-abdominal or retroperitoneal injury. This has been shown to significantly decrease the need for laparotomy without a concurrent increase in morbidity. All hollow viscus injuries need emergent laparotomy; however, isolated liver or spleen injuries are sometimes observed or undergo angioembolization.
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If you beleive you can do it then you WILL DO IT!! (by Mymeghhi)
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| Korotkoff
Forum Senior
Topics: 14
Posts: 164
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X-ray of the spine should be first to R/O cervical spine fracture.
As for the abdominal injuries, I am always confused.
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| drduck
Forum Guru
Topics: 82
Posts: 529
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thanks alot friend......
IVONNE any plans to become surgeon???
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