abdo and pelvic trauma

Question 1

3 types of abdo trauma that might need to manage

Answer 1

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

Question 2

5 investigations for abdo trauma

Answer 2

clinical exam useless

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

Question 3

what is U/S good for and 4 locations

Answer 3

good for blood, not organ injury

• RUQ
• LUQ
• bladder
• pericardium

Question 4

indications for US

Answer 4

• low BP

- need at least 400CC to be pos

Question 5

adv. and dis of US

Answer 5

adv. - non-invasive, portable, high spec

dis - EARLY, hard in obese

Question 6

when to use CT

Answer 6

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

Question 7

3 indications for laparotomy

Answer 7

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

Question 8

when can one manage non-operatively

Answer 8

• solid organ injuries

- hemo stability

Question 9

3 keys to abdo surgery

Answer 9

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

Question 10

what is problem with tamponade

Answer 10

abdo compartment syndrome

Question 11

what is problematic intra-abdo pressure

Answer 11

> 12

Question 12

what are effects of high IAP

Answer 12

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

Question 13

what is IAH vs. ACS

Answer 13

IAH is the lower end of a continuum

Question 14

2 ways to measure IAP

Answer 14

1. direct - cath. in cavity

2 indirect - bladder

Question 15

treat of ACS

Answer 15

open abdo and put temp cover on it

Question 16

why are pelvic fractures bad

Answer 16

• can bleed a lot

- high morb

Question 17

3 parts of pelvic diagnosis

Answer 17

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

Question 18

where are most pelvic bleeds from

Answer 18

• venous and bones more
• ## posterior aspect of pelvis

Question 19

3 ways to stop pelvic bleeds

Answer 19

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

Question 20

2 types of packing done in pelvic fractures

Answer 20

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

Question 21

whan to do angio

Answer 21

• contrast blush on CT

- # and low BP despite other measures

Question 22

2 definitive fracture treatments

Answer 22

1. external fixation

2. open reduction and internal fixation

Question 23

steps to PT with pelvic # and low BP

Answer 23

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