Abdominal Trauma

Front 1

Understand the following imaging procedures, when to use each and limitations of each: FAST

Back 1

focused assessment with sonography for trauma cna be performed in <3 min. Determines hemoperitoneum. not good for small amounts of fluid detection

Front 2

Understand the following imaging procedures, when to use each and limitations of each: CT

Back 2

organ specific abd injuries. Disadvantage; takes time, expensive.

Front 3

Understand the following imaging procedures, when to use each and limitations of each: MRI

Back 3

Good for soft tissue but expensive and takes a very long time

Front 4

Describe when the of serial examins are done for imaging

Back 4

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.

Front 5

Why are serial exams recommended

Back 5

increases the utility in identifying intraabdominal injuries

Front 6

Know the indications for a DPL

Back 6

screen for hemoperitoneum after blunt trauma. Identifies blood, is rapid safe and inexpensive but doesn't determine etiology.

Front 7

Know how to perform DPL, and how to interpret the results

Back 7

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 +

Front 8

Know how to determine if a stab wound penetrates the anterior fascia and how to proceed if it does

Back 8

DPL. If no violation of anterior fascia, pt can be dishcarged home. Positive, then local wound explorations can be performed

Front 9

Explain the indications for a laparotomy and how the indications may vary in a small community hospital versus a major medical center

Back 9

gold standard for intrabdominal injuries. In smaller communities where resources are limited, surgical exploration may be best served.

Front 10

Discuss which organs can be injured by blunt trauma to the abdomen. Understand the mechanism of injury resulting from blunt trauma to the abdomen

Back 10

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.

Front 11

Explain how solid organ injury may present differently from hollow organ injury

Back 11

Solid organs produce Sx by blood loss. Hollow produce Sx by combination of blood loss and peritoneal contamination.

Front 12

Know which patients will need more advanced evaluation after blunt trauma to the abdomen.

Back 12

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

Front 13

Understand what type of injury is most likely to injure retroperitoneal organs, how these injuries present and how to evaluate and manage them

Back 13

duodenal injuries: high-speed vertical or horizontal decelerating trauma. Asymptomatic, hours or days. pacreatic: rapid decelerating. hit steering wheel, bike handles. Few Sx's.

Front 14

Explain what findings suggest a diaphragmatic injury and discuss the difficulties in confirming the diagnosis

Back 14

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

Front 15

Discuss the criteria that are used to help determine if a solid visceral injury can be managed nonoperatively

Back 15

pt's without vascular injury usually can be managed nonooperatively. CT can identify vascular injuries

Front 16

Describe the areas in the abdomen where blood can be sequestered. Know how to detect it

Back 16

1.chest: CXR 2.abd: retroperitoneaum 3.pelvic film / MOI 4.muscle compartments: mass / hematoma 5.street: ask EMS

Front 17

What labs would you order to assess in initial trauma

Back 17

CBC, PT, PTT, BUN, Cr, electrolytes, amylase, T&C for 2-6 units PRBC's, ABG, serial hct

Front 18

What is DPL best used for

Back 18

intraperitoneal blood for detecting hollow viscus injuries

Front 19

What is CT best used for

Back 19

organ injuries, allows non-operative intervention, retroperitoneal structures and can grade extent of injury

Front 20

What is Ultrasound best used for

Back 20

free intraperitoneal fluid andis excellent screeing tool for blunt trauma

Front 21

What are the indications for surgical intervention

Back 21

failure to respond to fluid administration, deterioration of vitals, progressive adb distension, retroperitoneal air, +peritoneal lavage, falling hct

Front 22

Understand the significance of the types of pain listed below and how they correspond to various disease processes: Visceral

Back 22

Autonomic: stretching of autonomic nerve fibers surrounding a hollow viscus

Front 23

Understand the significance of the types of pain listed below and how they correspond to various disease processes: Parietal

Back 23

Somatic: px from inflammation of parietal peritoneum, sharper more localized

Front 24

Understand the significance of the types of pain listed below and how they correspond to various disease processes: Referred

Back 24

will be ipsilateral to affected organ, midline only if organ is midline

Front 25

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

Back 25

Upper: ulcer, gastritis, esophagitis, varices. Lower: hemorrhoids, divertic., polups, CA, infectious gastroenteritis

Front 26

ABDOMINAL TRAUMA

Back 26

ABDOMINAL TRAUMA