Abdominal trauma - Revision history

Rossdonaldson1: /* Management */

2020-01-27T04:57:32Z

Management

← Older revision		Revision as of 04:57, 27 January 2020
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	*[[ATLS]] algorithm for severe trauma		*[[ATLS]] algorithm for severe trauma
	**Vascular access		**Vascular access
	**Consider [[blood transfusion]] (and [[massive transfusion protocol]])		**Consider [[blood transfusion]] (and [[massive transfusion protocol]]) + [[TXA]]
	**Surgery consult (surgery vs. IR)		**Surgery consult (surgery vs. IR)
	**polytrauma, hypotension, free intraperitoneal fluid - immediate exploratory laparotomy		**polytrauma, hypotension, free intraperitoneal fluid - immediate exploratory laparotomy

Rossdonaldson1: /* Clinical Features */

2019-06-13T20:17:55Z

Clinical Features

← Older revision		Revision as of 20:17, 13 June 2019
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	==Clinical Features==		==Clinical Features==
	[[File:PMC4818312 gr2.png\|thumb\|Seat-belt sign after ~~trauma~~.]]		[[File:PMC4818312 gr2.png\|thumb\|Seat-belt sign after motor vehicle collision.]]
	*Typically, abdominal pain after trauma (blunt or penetrating)		*Typically, abdominal pain after trauma (blunt or penetrating)

Rossdonaldson1: /* Indications for laparotomy */

2019-06-13T17:48:38Z

Indications for laparotomy

← Older revision		Revision as of 17:48, 13 June 2019
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	===Indications for laparotomy===		===Indications for laparotomy===
	~~{\| class="wikitable"~~		*Blunt
	\|-		**Anterior abdominal injury with hypotension
	~~\| <br>~~		**Abdominal wall disruption
	~~\| '''~~Blunt ~~'''~~		**Peritonitis
	~~\| '''Penetrating'''~~		**Free air under diaphragm on chest radiograph
	\|-		**Positive FAST or DPL in hemodynamically unstable patient
	~~\| '''Absolute '''~~		**CT-diagnosed injury requiring surgery (i.e., pancreatic transection, duodenal rupture, diaphragm injury)
	\| Anterior abdominal injury with hypotension		*Penetrating
	~~\| Injury to abdomen, back, and flank with hypotension~~		**Injury to abdomen, back, and flank with hypotension
	\|-		**Abdominal tenderness
	\|		**GI evisceration
	\| Abdominal wall disruption		**High suspicion for transabdominal trajectory after gunshot wound
	~~\| Abdominal tenderness~~		**CT-diagnosed injury requiring surgery (i.e., ureter or pancreas)
	\|-
	\|
	\| Peritonitis
	~~\| GI evisceration~~
	\|-
	\|
	\| Free air under diaphragm on chest radiograph
	~~\| High suspicion for transabdominal trajectory after gunshot wound~~
	\|-
	\|
	\| Positive FAST or DPL in hemodynamically unstable patient
	\| CT-diagnosed injury requiring surgery (i.e., ~~ureter or pancreas~~)
	\|-
	\|
	\| CT-diagnosed injury requiring surgery (i.e., ~~pancreatic transection, duodenal rupture, diaphragm injury~~)
	\|
	\|-
	~~\| '''Relative '''~~
	~~\| Positive FAST or DPL in hemodynamically stable patient~~
	\|
	\|-
	\|
	~~\| Solid visceral injury in stable patient~~
	\|
	\|-
	\|
	~~\| Hemoperitoneum on CT without clear source~~
	\|
	\|}

	==Disposition==		==Disposition==

Rossdonaldson1: /* Management */

2019-06-13T16:57:57Z

Management

← Older revision		Revision as of 16:57, 13 June 2019
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	**Vascular access		**Vascular access
	**Consider [[blood transfusion]] (and [[massive transfusion protocol]])		**Consider [[blood transfusion]] (and [[massive transfusion protocol]])
			**Surgery consult (surgery vs. IR)
			**polytrauma, hypotension, free intraperitoneal fluid - immediate exploratory laparotomy
			**isolated bleed for angioembolization

	===Indications for laparotomy===		===Indications for laparotomy===

Rossdonaldson1: /* Disposition */

2019-06-13T16:56:35Z

Disposition

← Older revision		Revision as of 16:56, 13 June 2019
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	==Disposition==		==Disposition==
	===~~Stable~~===		===Discharge===
	*CT scan of the abdomen and pelvis negative, normotensive,		*CT scan of the abdomen and pelvis negative, normotensive
	*Penetrating		*Penetrating
	**Knife: If local wound exploration shows no violation of anterior fascia, suture laceration and discharge		**Knife: If local wound exploration shows no violation of anterior fascia, suture laceration and discharge
	**If CT shows a subcutaneous trajectory or minimal retroperitoneal violation, discharge home after period of observation		**If CT shows a subcutaneous trajectory or minimal retroperitoneal violation, discharge home after period of observation

	~~===Unstable===~~
	*IR vs Surgery
	**isolated bleed for angioembolization
	**polytrauma, hypotension, free intraperitoneal fluid - immediate exploratory laparotomy

	==See Also==		==See Also==

Rossdonaldson1: /* Management */

2019-06-13T16:55:51Z

Management

← Older revision		Revision as of 16:55, 13 June 2019
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	==Management==		==Management==
	''Nonoperative management is the norm in children, but not necessarily in adults.''		''Nonoperative management is the norm in children, but not necessarily in adults.''
			*[[ATLS]] algorithm for severe trauma
			**Vascular access
			**Consider [[blood transfusion]] (and [[massive transfusion protocol]])

	===Indications for laparotomy===		===Indications for laparotomy===

	{\| class="wikitable"		{\| class="wikitable"
	\|-		\|-

Rossdonaldson1: /* Imaging */

2019-06-13T16:53:29Z

Imaging

← Older revision		Revision as of 16:53, 13 June 2019
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	{{ATLS abd trauma diagnosis algorithm}}		{{ATLS abd trauma diagnosis algorithm}}

	===Imaging===		===Imaging Tests===
	[[File:Free fluid.png\|thumb\|Positive [[FAST]] (RUQ)]]		[[File:Free fluid.png\|thumb\|Positive [[FAST]] (RUQ)]]
	*Ultrasound ([[FAST exam\|FAST]])		*Ultrasound ([[FAST exam\|FAST]])

Rossdonaldson1: /* Evaluation */

2019-06-13T16:53:07Z

Evaluation

← Older revision		Revision as of 16:53, 13 June 2019
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	==Evaluation==		==Evaluation==
			{{ATLS abd trauma diagnosis algorithm}}

	===Imaging===		===Imaging===
	[[File:Free fluid.png\|thumb\|Positive [[FAST]] (RUQ)]]		[[File:Free fluid.png\|thumb\|Positive [[FAST]] (RUQ)]]
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	**CT with IV contrast only is typical standard		**CT with IV contrast only is typical standard
	***May consider triple-contrast (IV, PO, PR) if specific concern for viscous perforation, although delay to imaging typically prohibits this as the initial study		***May consider triple-contrast (IV, PO, PR) if specific concern for viscous perforation, although delay to imaging typically prohibits this as the initial study

	~~{{ATLS abd trauma diagnosis algorithm}}~~

	==Management==		==Management==

Rossdonaldson1: /* Clinical Features */

2019-06-13T16:50:56Z

Clinical Features

← Older revision		Revision as of 16:50, 13 June 2019
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	==Clinical Features==		==Clinical Features==
	[[File:PMC4818312 gr2.png\|thumb\|Seat-belt sign after trauma.]]		[[File:PMC4818312 gr2.png\|thumb\|Seat-belt sign after trauma.]]
	*Typically abdominal pain after trauma (blunt or penetrating)		*Typically, abdominal pain after trauma (blunt or penetrating)

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Clinical Features */

2019-06-13T16:50:12Z

Clinical Features

@@ Line 9: / Line 9: @@
 [[File:PMC4818312 gr2.png|thumb|Seat-belt sign after trauma.]]
 *Typically abdominal pain after trauma (blunt or penetrating)
 ==Differential Diagnosis==