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26 Cards in this Set

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Understand the following imaging procedures, when to use each and limitations of each: FAST
focused assessment with sonography for trauma cna be performed in <3 min. Determines hemoperitoneum. not good for small amounts of fluid detection
Understand the following imaging procedures, when to use each and limitations of each: CT
organ specific abd injuries. Disadvantage; takes time, expensive.
Understand the following imaging procedures, when to use each and limitations of each: MRI
Good for soft tissue but expensive and takes a very long time
Describe when the of serial examins are done for imaging
Must be performed by same clinician spanning 16-24h's. 1st: q 30 min. X 4h's, then hourly for 4-6 h's and finaly 2-4 for remainder of 24 hrs.
Why are serial exams recommended
increases the utility in identifying intraabdominal injuries
Know the indications for a DPL
screen for hemoperitoneum after blunt trauma. Identifies blood, is rapid safe and inexpensive but doesn't determine etiology.
Know how to perform DPL, and how to interpret the results
Closed or open. + if tap = 10 mL of free-flowing blood. If -, 1L of NS instilled and drained. 100K RBC per uL considered + lavage. Only 25 ML of blooed is +
Know how to determine if a stab wound penetrates the anterior fascia and how to proceed if it does
DPL. If no violation of anterior fascia, pt can be dishcarged home. Positive, then local wound explorations can be performed
Explain the indications for a laparotomy and how the indications may vary in a small community hospital versus a major medical center
gold standard for intrabdominal injuries. In smaller communities where resources are limited, surgical exploration may be best served.
Discuss which organs can be injured by blunt trauma to the abdomen. Understand the mechanism of injury resulting from blunt trauma to the abdomen
Organs moving within body can cause damage: lig of Treitz or distal small bowel & R colon. Falls: hollow vesceral rupture & retroperitoneal injuries because force is transmitted up axial skeleton. Peds struck by cars.
Explain how solid organ injury may present differently from hollow organ injury
Solid organs produce Sx by blood loss. Hollow produce Sx by combination of blood loss and peritoneal contamination.
Know which patients will need more advanced evaluation after blunt trauma to the abdomen.
ABD Px, tenderness, distention, MOI suggestive, lower chest or pelvic injury, high-speed collisions, MVC with fatalities, unprotected injury (motorcycle) presence of distracting injury (long bone fx) altered LOC
Understand what type of injury is most likely to injure retroperitoneal organs, how these injuries present and how to evaluate and manage them
duodenal injuries: high-speed vertical or horizontal decelerating trauma. Asymptomatic, hours or days. pacreatic: rapid decelerating. hit steering wheel, bike handles. Few Sx's.
Explain what findings suggest a diaphragmatic injury and discuss the difficulties in confirming the diagnosis
Plain chest film showing viscera in chest or NG tube coiled in thorax dx's diaphragm injury. DPL, CT, MRI can be helpful. Occasionally cavitary endoscopy or lap are necessary to dx
Discuss the criteria that are used to help determine if a solid visceral injury can be managed nonoperatively
pt's without vascular injury usually can be managed nonooperatively. CT can identify vascular injuries
Describe the areas in the abdomen where blood can be sequestered. Know how to detect it
1.chest: CXR 2.abd: retroperitoneaum 3.pelvic film / MOI 4.muscle compartments: mass / hematoma 5.street: ask EMS
What labs would you order to assess in initial trauma
CBC, PT, PTT, BUN, Cr, electrolytes, amylase, T&C for 2-6 units PRBC's, ABG, serial hct
What is DPL best used for
intraperitoneal blood for detecting hollow viscus injuries
What is CT best used for
organ injuries, allows non-operative intervention, retroperitoneal structures and can grade extent of injury
What is Ultrasound best used for
free intraperitoneal fluid andis excellent screeing tool for blunt trauma
What are the indications for surgical intervention
failure to respond to fluid administration, deterioration of vitals, progressive adb distension, retroperitoneal air, +peritoneal lavage, falling hct
Understand the significance of the types of pain listed below and how they correspond to various disease processes: Visceral
Autonomic: stretching of autonomic nerve fibers surrounding a hollow viscus
Understand the significance of the types of pain listed below and how they correspond to various disease processes: Parietal
Somatic: px from inflammation of parietal peritoneum, sharper more localized
Understand the significance of the types of pain listed below and how they correspond to various disease processes: Referred
will be ipsilateral to affected organ, midline only if organ is midline
Identify the most common causes of bleeding within the gastrointestinal (GI) system as well as how they present. Know the best way to evaluate and treat the patient with GI bleeding
Upper: ulcer, gastritis, esophagitis, varices. Lower: hemorrhoids, divertic., polups, CA, infectious gastroenteritis
ABDOMINAL TRAUMA
ABDOMINAL TRAUMA