Abdo Trauma

Question 1

Why are kids more susceptible to abdo trauma cf adults?

Answer 1

• More exposed organs - diaphragm makes them protrude more, liver and spleen pushed lower
• Less protective habitus - abdo wall is thin, reduced abdo musculature and subcut fat
• Smaller torso - same forces over smaller area
• Ribs more pliable
• Adult protection systems often ill fitting

Question 2

What injuries is a lap seatbelt trauma event likely to lead to?

Answer 2

• local trauma - umbilical ecchymosis
• high risk of bowel injury
• L1/L2 injury (-> chance fracture)

Question 3

What injuries is a handlebar trauma event likely to lead to?

Answer 3

liver and spleen injury

Question 4

What are the basic Ix you should order in abdo trauma?

Answer 4

• FBE, cross match, lipase, amylase, LFTs

- Urine analysis for all

Question 5

Why do they not really do FAST in paeds trauma?

Answer 5

• because evaluation of the fluid volume present in the abdomen can be difficult and ultimately the presence of blood is not an indication for surgery.
• Children can be mx more successfully with non-op mx, and less sensitive in children

Question 6

When do you not use an abdominal CT in trauma? Why are we cautious about it in paeds?

Answer 6

Contrast CTs can cause 1 case of cancer in 10 years:
○ No abdo wall/seatbelt signs
○ No GCS < 14
○ No abdo pain/tenderness
○ No vomiting
○ No thoracic wall trauma
○ No decreased breath sounds
○ *and failure of one of these doesn't necessarily mean an automatic CT

Question 7

Medical vs surgical Mx in abdo trauma - which is more common?

Answer 7

95% conservative Mx