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Flashcards in abdo and pelvic trauma Deck (23):
1

3 types of abdo trauma that might need to manage

1. low BP - determine cause
2. low BP and abdo bleed - laparotomy
3. norm BP and abdo bleed - further investigationvs

2

5 investigations for abdo trauma

clinical exam useless
1. U/S
2. CT
3. laparoscopy
4. angiography
5. wound exploration

3

what is U/S good for and 4 locations

good for blood, not organ injury
- RUQ
- LUQ
- bladder
- pericardium

4

indications for US

- low BP
- need at least 400CC to be pos

5

adv. and dis of US

adv. - non-invasive, portable, high spec
dis - EARLY, hard in obese

6

when to use CT

- only in stable Pt
- IV contrast
- good for Dx of solid organ probs
- misses hollow organs
- misses diaphram

7

3 indications for laparotomy

1. hemodynaimc instability
2. peritonitis
3. obvious diaphragmatic injury

8

when can one manage non-operatively

- solid organ injuries
- hemo stability

9

3 keys to abdo surgery

1. prevent/minimize
- hypothermia
- coagulopathy
- acidosis
2. deal with only life threatening issues
- tamponade bleeding (packs)
3. resus. in ICU

10

what is problem with tamponade

abdo compartment syndrome

11

what is problematic intra-abdo pressure

>12

12

what are effects of high IAP

CV- less blood return
Resp - less somliance, low FRC
renal - low/no urine
neuro - increased ICP

13

what is IAH vs. ACS

IAH is the lower end of a continuum

14

2 ways to measure IAP

1. direct - cath. in cavity
2 indirect - bladder

15

treat of ACS

open abdo and put temp cover on it

16

why are pelvic fractures bad

- can bleed a lot
- high morb

17

3 parts of pelvic diagnosis

1. clincal exam - mech instability
2. plain x-rays
3. CT

18

where are most pelvic bleeds from

- venous and bones more
- posterior aspect of pelvis
-

19

3 ways to stop pelvic bleeds

1. stabilize pelvis
- bind or sheet
2. surgery
3. angio and cuatery

20

2 types of packing done in pelvic fractures

1. extra-peritoneal
- midline incision below umbilicus
2. retro-peritoneal
- put in behind retracted bladder

21

whan to do angio

- contrast blush on CT
- # and low BP despite other measures

22

2 definitive fracture treatments

1. external fixation
2. open reduction and internal fixation

23

steps to PT with pelvic # and low BP

1. rule out additional sources of hypotension
2. pelvic binder or sheet
3. if FAST +
- OR or angio
3. if FAST -
- binder
4 if BP improves
- CT and then ICU

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