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ATLS-Abdominal Trauma Flashcards

(46 cards)

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1
Q

Penetrating injuries above and below what landmarks indicate the need to assess for intraperitoneal injury?

A

Below the nipple line, and above the perineum

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2
Q

What are the boundaries of the anterior abdomen?

A 
Superior = costal margins
Inferior = inguinal ligaments and pubis symphasis
Laterally = anterior axillary lines
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3
Q

What are the boundaries of the thoacoabdomen?

A 
Superior = Nipple line/infrascapular line
Inferior = costal margins
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4
Q

What diaphragm rises to what rib level during full expiration?

A

4th rib

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5
Q

What are the components of the SAD PUCKER mnemonic for the retroperitoneal organs?

A 
Supra Adrenal glands
Aorta
Duodenum
Pancreas
Ureters
Colon (ascending and descending)
Kidneys
Esophagus
Rectum
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6
Q

What intraperitoneal organs are injured most commonly in order?

A

Spleen
Liver
Small bowel

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7
Q

What is the difference in the type of damage caused by high and low velocity GSWs?

A 
High = more kinetic force
Slow = more shearing and cutting
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8
Q

What determines the speed of assessing whether internal bleeding is present?

A

Hypotensive = now

Hemodynamically stable and no peritoneal signs = later

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9
Q

Why is assessing the distance from the shooter important in GSW?

A

If shotgun, the damage decreases significantly the farther the shooter is

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10
Q

After stripping the patient and performing a thorough secondary exam, what should be done immediately?

A

Cover in blankets to prevent hypothermia

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11
Q

Laceration of the perineum, vagina, rectum, or buttocks in the trauma patient may suggest what injury?

A

Open pelvic fracture

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12
Q

When is auscultation of the abdomen most beneficial in the assessment of the traumatic abdomen?

A

When it changes over time

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13
Q

Why should manipulation of the traumatic pelvis be limited to one time?

A

May dislodge a clot and precipitate more bleeding

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14
Q

Should pelvic stability be performed in patients with shock?

A

No

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15
Q

What are the signs that a foley catheter should not be placed in a traumatic pelvis? (3)

A

High riding prostate
Blood at the urethral meatus
Perineal hematoma

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16
Q

When should a NG tube or Nasopharyngeal tube NEVER be used?

A

If suspecting a basilar skull fracture or ina midface injury

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17
Q

What is the role of NG tubes in the trauma pt?

A

Decreases gastric distention and reduces chances of aspiration

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18
Q

What is the only contraindication to performing the FAST exam?

A

Existing indication for laparotomy

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19
Q

What are the indications to perform advanced imaging on a hemodynamically stable patient? (5)

Study These Flashcards
A
  • Change in sensorium or sensation
  • Injury to spine or adjacent structures
  • Equivocal physical exam
  • Lap belt sign
  • Prolonged loss of contact with pt (e.g. anesthesia)
20
Q

Penetrating trauma above what anatomic landmark requires a CXR?

21
Q

While performing a DPL, what findings indicate the need for laparotomy?

Study These Flashcards
A

Blood, bile, or food material in the catheter

22
Q

What are the contraindications to a DPL? (4)

Study These Flashcards
A
  • Cirrhosis
  • Obesity
  • Previous abdominal surgeries
  • Coaqgulopathy
23
Q

What amount of fluids is used in DPL?

24
Q

When performing a DPL, what microscopic findings indicate a positive DPL? (3)

Study These Flashcards
A
  • RBCs over 100,000
  • 500 WBCs
  • Gram stain +
25
In the absence of hepatic or splenic injuries, the presence of free fluid in the abdominal cavity suggests what?
Injury to the GI tract or its mesentery
26
What organs can CT scans miss lacerations to? (3)
Pancreas Diaphragm Some GI
27
Suspected urinary injuries are best evaluated by what imaging? What if this is not available?
CT | IV pyelogram
28
If a trauma patient needed to be transported to another facility, should imaging be obtained?
No
29
What are the four indications for laparotomy for penetrating abdominal wounds?
- hemodynamically abnormal pt - GSW with transperitoneal trajectory - Signs of peritoneal injury - Signs of fascia penetration
30
How sensitive are serial exams in detecting abdominal injury?
upper 90%
31
What is the chance of significant abdominal organ injury with GSWs that penetrate the peritoneum?
98%+
32
If the duodenum is ruptured, where will air accumulate and be seen on x-ray?
Retroperitoneal
33
What is the most common mechanism of pancreatic injury?
Smashed against the vertebral column
34
What is the role of amylase in detection of pancreatic injuries?
- May not be elevated early | - May be from other sources
35
What are the two major types of urethral injuries?
- Posterior = above the urogenital diaphragm | - Anterior = Below the urogenital diaphragm
36
Why are hollow viscus injuries hard to diagnose?
They may only produce minimal hemorrhage
37
What determines if a patient with a solid organ injury needs an emergent laparotomy?
If hemodynamically stable and no signs of continued bleed, can watch
38
Pelvic fractures with hemorrhage often have disruption of what tissue planes? (2)
Posterior osseous ligaments and pelvic floor
39
What are the four major mechanisms/classifications of pelvic injuries?
1. AP compression 2. Lateral compression 3. Vertical shear 4. Complex (combination) pattern
40
Why do AP pelvic compression injuries typically produce urethral injuries?
Pubis symphysis is displaced and shears the urethral
41
What type of pelvic fracture is the least likely to be lethal? Why?
Lateral, since there is generally no disruption of pelvic vasculature
42
What is the anatomic site of application for a pelvic binder?
At the level of the greater trochanters
43
What are the stabilizing measures for a pelvic fracture?
Pelvic binder and fluids
44
What is a common complication of pelvic binders that needs to be watched for?
Skin breakdown
45
What is the decision point for determining if a hemorrhaging pelvic fracture needs a laparotomy vs angiography?
If there is gross intraperitoneal blood, then laparotomy
46
Is it more helpful to have a full or empty bladder when performing a fast exam? why?
Full--helps to delineate intraperitoneal fluid

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