drms
Forum Guru
Topics: 14
Posts: 947
|
drnadeemusmani wrote:
laparatomy- he has splenic rupture and haemodynamically unstable
Agree 
___________________
“It is a funny thing about life; if you refuse to accept anything but the best, you very often get it.”
|
| DrAlex_76
Forum Guru
Topics: 120
Posts: 410
|
blunt abdominal trauma, suspect hemoperitoneal then 1st thing to do is US.
If US positive, then go surgery.
|
| pr20
Forum Senior
Topics: 24
Posts: 180
|
This is a UW question and answer is given as 9.Focussed assesment with ultrasound.
Following is the management for Blunt Abdominal Trauma:
1.If the pt is hemodynamically stable---> Do CT scan of the abdomen
2.If the pt is hemodynamically unstable,proceed in the following order
a.IV fluid rescuciation
b.Followed by Ultrasound abdomen
c.If U/S is not definitive,do Diagnostic Peritoneal Lavage(DPL)
If either U/S or DPL demonstrates hemoperitoneum(blood),the patient should then undergo Laprotomy and surgical repair.
But it also says that if a patient has clear cut peritoneal signs(eg.guarding and rigidity) OR if the pt is hemodynamically unstable even after IV fluid rescuciation---->then directly go for Emergency Laprotomy.
My doubt is...in this above case pt has a BP of 90/60 mmhg even after giving 2L of IV fluids...does this not warrant an emergency laprotomy???
|
| romano
Forum Newbie
Topics: 4
Posts: 24
|
pr20 wrote:
This is a UW question and answer is given as 9.Focussed assesment with ultrasound.
Following is the management for Blunt Abdominal Trauma:
1.If the pt is hemodynamically stable---> Do CT scan of the abdomen
2.If the pt is hemodynamically unstable,proceed in the following order
a.IV fluid rescuciation
b.Followed by Ultrasound abdomen
c.If U/S is not definitive,do Diagnostic Peritoneal Lavage(DPL)
If either U/S or DPL demonstrates hemoperitoneum(blood),the patient should then undergo Laprotomy and surgical repair.
But it also says that if a patient has clear cut peritoneal signs(eg.guarding and rigidity) OR if the pt is hemodynamically unstable even after IV fluid rescuciation---->then directly go for Emergency Laprotomy.
My doubt is...in this above case pt has a BP of 90/60 mmhg even after giving 2L of IV fluids...does this not warrant an emergency laprotomy???
If the patient is hemodynamically unstable or not is a though question. However, "unstable" means that the blood is not able to do it's job, deliver nutrients, oxygen etc. In this case 90/60 is probably enough to do that. It is believed that a MAP that is greater than 60 mmHg is enough to sustain the organs of the average person, in this case the MAP is just above that. The fact that the patient has alreday been given two liters of IV fluids doesn't change the scenario. As long the MAP is over 60, the patient should be considered as hemodynamically stable.
However, in real life things are about to change very quickly. MAP can drop quickly or fluctuate, but this is "just" a UW question and I think this is how you should come up to the answer of choosing US first.
|
| nightflight1945
banned
Topics: 32
Posts: 920
|
romano wrote:
If the patient is hemodynamically unstable or not is a though question. However, "unstable" means that the blood is not able to do it's job, deliver nutrients, oxygen etc. In this case 90/60 is probably enough to do that. It is believed that a MAP that is greater than 60 mmHg is enough to sustain the organs of the average person, in this case the MAP is just above that. The fact that the patient has alreday been given two liters of IV fluids doesn't change the scenario. As long the MAP is over 60, the patient should be considered as hemodynamically stable.
However, in real life things are about to change very quickly. MAP can drop quickly or fluctuate, but this is "just" a UW question and I think this is how you should come up to the answer of choosing US first.
The patient is not stable , this is the reason that we don't go for CT , however his partial response to IV fluids and the fact that his BP esp diastolic is relatively good for tissue perfusion(60) , would bought us some time to further evaluate him .
If after IV administration the BP was the same or at least MAP<70 I would go for laparotomy.
and FAST is a bedside procedurez(also DPL) that can be done in OR.
|
| romano
Forum Newbie
Topics: 4
Posts: 24
|
nightflight1945 wrote:romano wrote:
If the patient is hemodynamically unstable or not is a though question. However, "unstable" means that the blood is not able to do it's job, deliver nutrients, oxygen etc. In this case 90/60 is probably enough to do that. It is believed that a MAP that is greater than 60 mmHg is enough to sustain the organs of the average person, in this case the MAP is just above that. The fact that the patient has alreday been given two liters of IV fluids doesn't change the scenario. As long the MAP is over 60, the patient should be considered as hemodynamically stable.
However, in real life things are about to change very quickly. MAP can drop quickly or fluctuate, but this is "just" a UW question and I think this is how you should come up to the answer of choosing US first.
The patient is not stable , this is the reason that we don't go for CT , however his partial response to IV fluids and the fact that his BP esp diastolic is relatively good for tissue perfusion(60) , would bought us some time to further evaluate him . If after IV administration the BP was the same or at least MAP<70 I would go for laparotomy. and FAST is a bedside procedurez(also DPL) that can be done in OR.
My book clerly states that MAP > 60 is enough, however, "normal range" is 70 - 110... Stable enough to go with the US, of course not a CT...
UW states that a hemodynamically stable patient should undergo US at first (immediately), maybe "hemodynamically stable" is just the wrong term to use?
|
|
| |
| | | | | | |
