3 - Abdominal Trauma Flashcards
(51 cards)
Abdominal trauma accounts for?
15-20% of all trauma deaths
You survived the initial abdominal injury, now what kills you?
Sepsis
MCC of blunt abdominal trauma?
MVC
Falls can do it too
Typical blunt intra-abdominal trauma is?
Hollow viscous rupture
Penetrating abdominal injury considerations?
Bullets:
- cavitation injury
- secondary missiles (bone etc)
Stab/FOB:
- length, trajectory and frag may be ukn during initial eval
Assume penetrating abdominal trauma with:
Any injury to:
- lower chest
- pelvis
- flank
- back
Is considered penetrating injury until proven otherwise
Problem with abdominal injuries (and really most inj) with young healthy pts?
They compensate for intra-abdominal hemorrhage before clinical signs become overt
They compensate, compensate, compensate, die
Symptoms of abdominal contusion?
Pain w flexion, rotation
Focal tenderness
Hematoma
- Palpable mass inferior to umbilicus
S/s of solid organ damage?
Gen due to blood loss
- increase in pulse pressure
- pain and bleeding may be minimal
- delayed rupture is a thing with liver and spleen
= 15% blood loss presentation?
Can have increased pulse pressure as the only clue
- be cautious w sig MOI and increased pulse
Spleen and liver inj presentation?
Spleen - may refer to L shoulder/arm
Liver - may refer to right shoulder
What is a condition that predisposes people to splenic inj?
Pregnancy
Mononucleosos
Bicycles
In blunt abd trauma, 5% incidence of?
Blunt bowel and mesenteric injuries
Hollow viscus injuries produce what symptoms?
Combination of:
- blood loss
- peritoneal contamination w/ GI contents
Hemorrhage from mesenteric inj?
May be minimal and easily missed on PE
Chemical irritation of peritoneum presentation?
Gastric acid contents may produce:
- immediate pain
- But bacterial contamination may delay s/s
- delays increase mortality
Previlence of pancreatic injuries?
4% of abd trauma
- but sig morbidity and mortality
S/s of pancreatic inj?
No specific but look for:
- MOI - rapid deceration
- no seatbelt, bicycle handle bars
Duodenal inj?
Relatively asymptomatic
- small hematoma of duodenum may go undiagnosed
- gastric outlet obstruction developes as it expands
When to consider duodenal rupture?
High-veolicity deceleration events where intraluminal pressure of pylorus and proximal small bowel rapidly increases
Delayed presentation of duodenal rupture?
Fever and leukocytosis herald the development of sepsis
What happens when you knock the wind out of a pt?
Diaphragm spasms (2/2 blow to epigastrium)
- difficulty breathing
- diaphragm cannot relax
- lungs cannot expand
- relaxes slowly
Diaphragmatic rupture
Rare (0.8-5%) of pts with thoracoabdominal inj
- left sided phenomenon
What if you miss a diaphragmatic injury?
May lead to:
- delayed herniation
- strangulation of abdominal contents through defect
