Abdominal Trauma
1. Exsanguinating patient with hypothermia & coagulopathy who is unstable
2. Inability to control bleeding by direct hemostasis
3. Inability to close abdomen w/o tension
4. Expected long time operation - ANS-What are 4 indications for damage control surgery?
1. Hypothermia
2. Coagulopathy
3. Severe acidosis - ANS-What are the components of the lethal triad of trauma?
1. Primary operation & hemorrhage control
2. Critical care
3. Planned re-operation - ANS-What are the 3 phases of damage control?
1. Tougher splenic capsule
2. Lower grade injuries more common
3. Fewer associated injuries - ANS-3 reasons why children tend to be candidates for
conservative management of splenic injuries
6 months - ANS-Patients with a splenic injury who are managed conservatively may not
participate in contact sports for at least (blank)
95%
*these patients are going to the OR no matter what so no need to obtain much imaging -
ANS-With a gun shot wound to the abdomen, there is a (blank) probability of significant visceral
injury
Abdominal compartment syndrome
Multiple organ failure
Intra-abdominal abscess
Sepsis - ANS-4 complications of damage control surgery
conservative management
*but if they're unstable, they go to the OR immediately - ANS-Stable patients with a grade 1 or 2
splenic injury may be candidates for (blank)
Continued bleeding despite normalization of coagulation functions
, Intra-abdominal pressure > 25cm water with complication of abdominal compartment syndrome
- ANS-What are 2 reasons why an unplanned re-operation may occur following damage control
surgery?
Diagnostic peritoneal lavage
CT
US - ANS-What are 3 diagnostic aids that are key to identifying patients with blunt abdominal
trauma that need surgical exploration?
emergency laparotomy - ANS-A FAST is useful because it confirms the likely need for (blank)
FAST - ANS-Diagnostic peritoneal lavage is being replaced by (blank)
Focused Assessment with Sonography for Trauma
*rapidly assesses for intraperitoneal fluid - ANS-What does FAST stand for?
Gross blood > 5cc or frank blood on aspiration
RBC > 100,000/mm3 (blunt trauma)
RBC > 10,000/mm3 (penetrating trauma)
WBC > 500/mm3
Bile, bacteria or fecal contamination
Vegetable matter or succus entericus
Amylase > serum amylase
Lavage fluid of chest tube or bladder catheter - ANS-What are considered positive DPL
findings?
Gunshot wound
Evisceration
Peritoneal signs
Rigid or silent abdomen
Unexplained shock
Positive result on DPL
Radiologic evidence of intraperitoneal gas or ruptured diaphragm
Intra-peritoneal bladder injury - ANS-What are some indications for exploratory laparotomy?
hematocrits
*and cardiovascular monitoring - ANS-Patients who are managed conservatively for a splenic
injury will require serial (blank)
hemorrhage - ANS-Death from abdominal injuries is primarily due to (blank)
1. Exsanguinating patient with hypothermia & coagulopathy who is unstable
2. Inability to control bleeding by direct hemostasis
3. Inability to close abdomen w/o tension
4. Expected long time operation - ANS-What are 4 indications for damage control surgery?
1. Hypothermia
2. Coagulopathy
3. Severe acidosis - ANS-What are the components of the lethal triad of trauma?
1. Primary operation & hemorrhage control
2. Critical care
3. Planned re-operation - ANS-What are the 3 phases of damage control?
1. Tougher splenic capsule
2. Lower grade injuries more common
3. Fewer associated injuries - ANS-3 reasons why children tend to be candidates for
conservative management of splenic injuries
6 months - ANS-Patients with a splenic injury who are managed conservatively may not
participate in contact sports for at least (blank)
95%
*these patients are going to the OR no matter what so no need to obtain much imaging -
ANS-With a gun shot wound to the abdomen, there is a (blank) probability of significant visceral
injury
Abdominal compartment syndrome
Multiple organ failure
Intra-abdominal abscess
Sepsis - ANS-4 complications of damage control surgery
conservative management
*but if they're unstable, they go to the OR immediately - ANS-Stable patients with a grade 1 or 2
splenic injury may be candidates for (blank)
Continued bleeding despite normalization of coagulation functions
, Intra-abdominal pressure > 25cm water with complication of abdominal compartment syndrome
- ANS-What are 2 reasons why an unplanned re-operation may occur following damage control
surgery?
Diagnostic peritoneal lavage
CT
US - ANS-What are 3 diagnostic aids that are key to identifying patients with blunt abdominal
trauma that need surgical exploration?
emergency laparotomy - ANS-A FAST is useful because it confirms the likely need for (blank)
FAST - ANS-Diagnostic peritoneal lavage is being replaced by (blank)
Focused Assessment with Sonography for Trauma
*rapidly assesses for intraperitoneal fluid - ANS-What does FAST stand for?
Gross blood > 5cc or frank blood on aspiration
RBC > 100,000/mm3 (blunt trauma)
RBC > 10,000/mm3 (penetrating trauma)
WBC > 500/mm3
Bile, bacteria or fecal contamination
Vegetable matter or succus entericus
Amylase > serum amylase
Lavage fluid of chest tube or bladder catheter - ANS-What are considered positive DPL
findings?
Gunshot wound
Evisceration
Peritoneal signs
Rigid or silent abdomen
Unexplained shock
Positive result on DPL
Radiologic evidence of intraperitoneal gas or ruptured diaphragm
Intra-peritoneal bladder injury - ANS-What are some indications for exploratory laparotomy?
hematocrits
*and cardiovascular monitoring - ANS-Patients who are managed conservatively for a splenic
injury will require serial (blank)
hemorrhage - ANS-Death from abdominal injuries is primarily due to (blank)
