abdominal trauma (originally mine) new.ppt

8/9/2019 abdominal trauma (originally mine) NEW.ppt

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Introduction

Divided into two types : Blunt

Crushing injury Hit by car

Penetrating Dog bites Projectile: Gunshot Stab or Impale

Patient can suer both eg! patient who involved in motor vehicle crashes

may be impaled on objects at the same time

"apid# li$e%threatening bleeding can behidden in the abdomen


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Blunt Trauma

)ost common mechanism o$ injury seen in *S

Diuse injury pattern

Biomechanics involve!

Compression Crushing Shearing Stretching $orces

&alls $rom height will produce a uni+uepattern o$ injury,

-he severity depends on the distance# sur$ace


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Marks of impact sustained by the

front-seat passenger in a carcrash


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Penetrating Trauma

Stabs wound Directly injure tissue as the blade passes through the

body (ny stab wound in the lower chest# pelvis# .an/ or

bac/ has caused abdominal injury until provenotherwise

Gunshot wound Bullets designed to brea/ apart once enter the body

Bullets may injure directly!

Secondary missiles# such as bone or bullet $ragments or!

&rom energy transmitted $rom the bullet

0ntrance and e1it wound can appro1imate themissile trajectory


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Abdominal Anatomy

Periumbilical area 'ocated around 7peri8 the navel

7umbilicus8

Small bowel lies in all +uadrants inperiumbilical area

Suprapubic area

'ocated just above pubic bone *rinary bladder# uterus lie in this area

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Abdominal Cavity

Peritoneum abdominal cavity lining

Divides abdomen into two spaces

Peritoneal cavity "etroperitoneal space

;A< ccintraperitoneal .uid

Particularly poor at detecting

bowel and mesenterydamage 7?? sensitivity8 Dicult to assess

retroperitoneum 'imited by habitus in obese

patients


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http://www.trauma.org/archive/radiology/FASTruq.html


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http://www.trauma.org/archive/radiology/FASTpericardium.htmlhttp://www.trauma.org/archive/radiology/FASTpelvis.htmlhttp://www.trauma.org/archive/radiology/FASTluq.htmlhttp://www.trauma.org/archive/radiology/FASTruq.html


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CT scan

C- is recommended $or evaluation o$hemodynamically stable patients with

e+uivocal =ndings on physical e1amination#associated neurologic injury# or multiple e1tra%abdominal injuries,

C- is the diagnostic modality o$ choice $ornonoperative management o$ solid visceralinjuries,


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oes )AST replace CT&

6nly at the e1tremes, *nstable patient# 7F8 &(S- 6" Stable patient# low $orce injury# 7%8 &(S- consider

observing patient,

C- is $ar more sensitive than &(S- $or detecting andcharacteriEing abdominal injury in trauma, -hegold standard $or characteriEing intraparenchymalinjury,

TDeath begins with a C-,U Qever send an unstablepatient to C-, &(S-# however# can be per$ormedduring resuscitation,


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+AST Algorithm* ,nstable

Eastern Association for the Surgery of Trauma, 2001


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+AST Algorithm* Stable

Eastern Association for the Surgery of Trauma, 2001


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Stab %ounds

Physical e1amination Serial P0# are accurate in evaluating stabwound

DP' Closed techni+ue -he accuracy increases $rom KJ%9%>?

hr

'ocal wound e1ploration Surgical procedure re+uire e1pertise I$ no violation o$ anterior $ascia# Discharge I$ $ascial violation# DP' can con=rmed

diagnosis


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#unshot %ounds

-o determine whether the missiletraverse the peritoneal cavity

)ostly re+uiring surgery

Penetrating trauma to the bac/ and.an/ can be investigated with contrastenhanced C- enema

'i/ewise# &(S- is now being used $or

penetrating trauma ( Fve &(S- has a Fve predictive value o$

L9


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Management

(irway : establish and maintain

Breathing : High .ow 6> $or

conscious pt, unconscious pt mayre+uire intubation

Circulation : > large bore branula, In

haemodynamically unstable pt# .uidresuscitation

Send blood $or G4)# &BC# B*S0creat

!rinciples of ATLS should be follo"ed "ith priorities

given to #


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Management

Surgical intervention only eective therapy 'aparotomy is the Tgold standardU therapy De=nitive# rarely misses an injury (llows $or complete evaluation o$ the abdomen

and retroperitoneum

Indication $or immediate laparatomy 0visceration# stab wounds with implement in%

situ and gunshot wounds traversing theabdominal cavity

(ny penetrating injury with haemodynamicinstability or peritoneal irritation

Persistent upper or lower GI bleed 4 ray evidence o$ pneumoperitoneum or

diaphragmatic rupture


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abdominal trauma (originally mine) new.ppt

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