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42 Cards in this Set
- Front
- Back
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What are the three most commonly injured organs? |
Liver, spleen, and bladder |
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Name some of the main sites of internal hemorrhage. |
-GI tract -pericardium -thoracic cavity -peritoneal cavity -SQ and muscular tissues |
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Name 3 emergency tests that can be used to localize internal hemorrhage. |
Radiographs, ultrasound, abdominocentesis |
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What are the two most common sequelae of abdominal trauma? |
Hemoabdomen, uroabdomen |
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Name three physical findings that may indicate intra-abdominal injury. |
-bruising around the umbilicus -hematuria -bruising in the inguinal area |
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What is the problem with using radiography to identify free fluid in the abdomen? |
It takes a lot of fluid to become visible, so the fluid may accumulate for several hours before it is able to be seen |
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What is the goal of an AFAST exam? |
To look for free fluid in the abdomen |
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How many sites are evaluated in an AFAST exam? List them. |
4 sites - sub-xyphoid, bladder, left flank/kidney, right kidney |
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When should abdominocentesis be performed? |
-any animal that presents in shock with no identifiable cause -animals that have free fluid identified on ultrasound or radiograph |
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When should the 4 quadrant tap be used? |
When an ultrasound isn't available and the abdominocentesis must be done blind |
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If fluid pulled from the abdomen doesn't clot, what does this indicate? |
It is likely free fluid in the abdomen, since all the clotting factors have been used up |
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If fluid pulled from the abdomen clots, what does this indicate? |
It is from the liver, spleen, or a vessel |
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What findings suggest hemoabdomen, but do not confirm it? |
-low PCV/TS -fluid in abdomen on radiograph or ultrasound |
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What finding confirms hemoabdomen? |
Finding non-clotting blood from an abdominocentesis |
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Why do we aim for the low end of resuscitation endpoints in a hemoabdomen patient? |
High pressures may pop the clot off and cause more hemorrhage |
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In a patient with hemoabdomen, what is our endpoint for systolic blood pressure? |
80 mmHg |
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In a patient with hemoabdomen, what is our endpoint for heart rate? |
140 bpm |
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In a patient with hemoabdomen, how do we aim to reduce lactate? |
Reduce it by 20% in 1h and 50% in 6h |
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What are the contraindications to abdominal counter pressure? |
Diaphragmatic hernia, intracranial pressure, lung injury |
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When should abdominal counter pressure be removed? |
When the animal is cardiovascularly stable, and the bleeding is under control |
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What is the consequence of having abdominal counter pressure on for too long? |
Organ damage from abdominal compartment syndrome |
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How should abdominal counter pressure be removed, and why? |
Slowly, and in a serial manner. This is because a sudden release of pressure could cause clots to dislodge and hemorrhage to reoccur. |
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When should surgery be considered for a hemoabdomen? |
Patient fails to respond to therapy by stabilizing, or it re-enters a state of shock, evidence of continued abdominal bleeding, or patient has multiple problems |
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When should a blood transfusion be considered for a hemoabdomen? |
-failure to achieve endpoints of resuscitation with fluids -relapse of shock after successful fluid resuscitation -continually falling hematocrit during fluid resuscitation |
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What does it mean if the PCV from the abdominal fluid differs from the peripheral PCV? |
If the PCV from the abdominal fluid is lower, it indicates something is diluting the fluid - this is usually a uroabdomen |
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What does it mean if PCV from abdominal fluid is the same as the peripheral PCV? |
There is hemorrhage - hemoabdomen |
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Beside PCV, how can fluid from a suspected uroabdomen be compared to peripheral blood? |
K+ ratio or creatinine ratio, or use an azostick to compare BUN levels |
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In a uroabdomen, what is the suspected K+ ratio between the abdomen and peripheral blood? |
>1.4:1 |
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In a uroabdomen, what is the suspected creatinine ratio between the abdomen and peripheral blood? |
>2:1 |
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In a uroabdomen, what will an Azostick show from the abdominal fluid compared to the peripheral blood? |
Abdominal fluid - 50-80 Peripheral blood - 15-26 |
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What are some tests that may support/suggest a uroabdomen? |
-bloodwork (azotemia) -radiographs -ultrasound -abdominocentesis |
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What is the one confirmatory test for uroabdomen? |
Abdominal fluid analysis |
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What are the different sources of a uroabdomen? |
-bladder -urethra -kidneys -ureters |
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What type of injuries is uroabdomen often associated with? |
Low speed injuries |
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A patient with vomiting and lethargy 24-48 hours post-trauma should be considered for what problem? |
Uroabdomen |
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When should a patient with uroabdomen be operated on? |
Not until AFTER they are stabilized - non-uremic, other life threatening injuries dealt with |
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Describe basic therapy for a patient with uroabdomen. |
-fluid resuscitation -pain control -urinary catheter -address other injuries -abdominal drainage (if chronic or surgery is delayed) -surgery |
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What happens if a uroabdomen goes undetected for a few days? |
Patient becomes azotemic |
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What can be used to treat uroabdomen that has progressed to azotemia? |
Peritoneal dialysis catheter |
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What are non-surgical cases of uroabdomen? |
Small bladder or urethral tears |
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How can non-surgical cases of uroabdomen be managed? |
Indwelling urinary catheter for 3-10 days |
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What can be done to localize urinary leakage? |
-contrast urethrogram/cystogram -IV urogram |
