ATLS MODULE 5 ABDOMINAL & PELVIC
TRAUMA
1. in a patient with penetrating trauma, what is the goal of the rectal exam?-
Answer: assess sphincter integrity & look for gross blood which could indicate a
bowelperforation
2. what do you have to check for in unresponsive menstruating women?
Answer: ex-amine the vagina for presence of tampons... if left in place, they can
cause delayedsepsis
3. penetrating injuries to the gluteal region (from iliac crest to gluteal folds)are
associated with?
Answer: 50% incidence of significant intraabdominal injuries
4. what does the presence of blood in gastric contents collected via gastrictube
suggest?
Answer: injury to esophagus or upper GI tract if nasopharyngeal and or
oropharyngeal sources are excluded
5. why do you delay placing a urinary catheter if FAST is being considered?-
Answer: full bladder enhances the pelvic images of FAST
6. does the absence of hematuria exclude injury to genitourinary tract?
Answer: no
7. when is a retrograde urethrogram mandatory?
Answer: pt is unable to void, requirespelvic binder, or has blood at the meatus, scrotal
hematoma, or perineal ecchymosis
*to reduce increasing complexity of urethral injury, confirm intact urethrae before
inserting urinary catheter
8. what is the only contraindication to FAST or DPL?
Answer: existing indication forlaparotomy
9. what patient findings require further abdominal eval to id or exclude intra-
abdominal injury?
Answer:
-altered sensorium
, -altered sensation
-injury to adjacent structure (lower ribs, pelvis, lumbar spine)
-equivocal Physical exam
-seatbelt sign w suspicion of bowel injury
10. many studies can provide useful information to intra-abdominal injuries...
however, which studies are doing if there are already indications for patient
transfer?
Answer: do not perform time consuming tests, including abdominal CT
11. what type of x-ray is recommended for assessing patients with multisystem
blunt trauma?
Answer: AP chest x-ray
*unless they are hemodynamically unstable
*if pt is hemodynamically stable and has penetrating trauma above umbilicus or sus-
pected thoracoabdominal injury, upright chest x-ray is useful to exclude hemo/pneu-
mothorax
12. how should you perform an x-ray in hemodynamically normal penetrating
trauma patients to determine the path of the missle and presence of tretroperi- toneal
air?
Answer: apply radiopaque markers or clips to all entrance and exit wounds
*obtaining AP & lateral views may allow for spatial orientation of foreign bodies
13. what are the disadvantages of the FAST exam?
Answer:
-bowel gas and subQ air candistort images
-can miss diaphragm, bowel, and pancreatic injuries
-does not completely assess retroperitoneal structures
-does not visualize extraluminal air
-body habitus can limit image clarity
14. what are the indications for DPL or FAST?
Answer:
-abnormal hemodynamics in bluntabdominal trauma
-penetrating abdominal trauma w/o other indications for immediate laparotomy
TRAUMA
1. in a patient with penetrating trauma, what is the goal of the rectal exam?-
Answer: assess sphincter integrity & look for gross blood which could indicate a
bowelperforation
2. what do you have to check for in unresponsive menstruating women?
Answer: ex-amine the vagina for presence of tampons... if left in place, they can
cause delayedsepsis
3. penetrating injuries to the gluteal region (from iliac crest to gluteal folds)are
associated with?
Answer: 50% incidence of significant intraabdominal injuries
4. what does the presence of blood in gastric contents collected via gastrictube
suggest?
Answer: injury to esophagus or upper GI tract if nasopharyngeal and or
oropharyngeal sources are excluded
5. why do you delay placing a urinary catheter if FAST is being considered?-
Answer: full bladder enhances the pelvic images of FAST
6. does the absence of hematuria exclude injury to genitourinary tract?
Answer: no
7. when is a retrograde urethrogram mandatory?
Answer: pt is unable to void, requirespelvic binder, or has blood at the meatus, scrotal
hematoma, or perineal ecchymosis
*to reduce increasing complexity of urethral injury, confirm intact urethrae before
inserting urinary catheter
8. what is the only contraindication to FAST or DPL?
Answer: existing indication forlaparotomy
9. what patient findings require further abdominal eval to id or exclude intra-
abdominal injury?
Answer:
-altered sensorium
, -altered sensation
-injury to adjacent structure (lower ribs, pelvis, lumbar spine)
-equivocal Physical exam
-seatbelt sign w suspicion of bowel injury
10. many studies can provide useful information to intra-abdominal injuries...
however, which studies are doing if there are already indications for patient
transfer?
Answer: do not perform time consuming tests, including abdominal CT
11. what type of x-ray is recommended for assessing patients with multisystem
blunt trauma?
Answer: AP chest x-ray
*unless they are hemodynamically unstable
*if pt is hemodynamically stable and has penetrating trauma above umbilicus or sus-
pected thoracoabdominal injury, upright chest x-ray is useful to exclude hemo/pneu-
mothorax
12. how should you perform an x-ray in hemodynamically normal penetrating
trauma patients to determine the path of the missle and presence of tretroperi- toneal
air?
Answer: apply radiopaque markers or clips to all entrance and exit wounds
*obtaining AP & lateral views may allow for spatial orientation of foreign bodies
13. what are the disadvantages of the FAST exam?
Answer:
-bowel gas and subQ air candistort images
-can miss diaphragm, bowel, and pancreatic injuries
-does not completely assess retroperitoneal structures
-does not visualize extraluminal air
-body habitus can limit image clarity
14. what are the indications for DPL or FAST?
Answer:
-abnormal hemodynamics in bluntabdominal trauma
-penetrating abdominal trauma w/o other indications for immediate laparotomy
