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Blunt Abdominal Trauma

Blunt Abdominal Trauma. Jen Nicol PGY-2 Dr. Rob Lafreniere August 5 th , 2010. Objectives. Physical Exam in BAT 3 important diagnostic modalities Management goals in BAT Hematuria in BAT Common pitfalls. Objectives. Physical Exam in BAT. Accuracy of physical exam in BAT is 55-65%.

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Blunt Abdominal Trauma

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  1. Blunt Abdominal Trauma Jen Nicol PGY-2 Dr. Rob Lafreniere August 5th, 2010

  2. Objectives • Physical Exam in BAT • 3 important diagnostic modalities • Management goals in BAT • Hematuria in BAT • Common pitfalls

  3. Objectives • Physical Exam in BAT

  4. Accuracy of physical exam in BAT is 55-65%

  5. In the alert patient • Pain • Tenderness with guarding • Peritoneal findings • High index of suspicion

  6. Unreliable Findings • Equivocal exam • +/- normal physical exam

  7. Buckle up!

  8. Mesentery injury • Bowel perforation, contusion • Rib & spine fractures • Diaphragm injury (rare) Big Badness!

  9. What is wrong with this picture?

  10. ChanceFracture

  11. Most common L1-3 50% con-current abdominal injuries

  12. Objectives • 3 important diagnostic modalities

  13. If we all had these..... It would be easy

  14. Negative FAST Pain Hematuria Decreasing hematocrit levels

  15. FAST outcomes

  16. CAT Scan

  17. Established need for laparotomy Prior abdominal surgery Infection Obesity Coagulopathy 2/3rd trimester pregnancy

  18. Sensitivity 87-95%Specificity 97-99%Accuracy 92-98%

  19. Positive DPL In BAT: >10 mL aspirated blood >100,000 RBC on lavage Lavage output thorughfoley or chest tube 20,000-100,000 RBC indeterminite in BAT

  20. DPL falsely negative in 25% of diaphragm injury

  21. Objectives • Management goals in BAT

  22. Management Goals: Stabilize the patient Determine presence of intraperitonealhemorrhage Demonstrate organ injury requiring operative intervention Don’t miss injuries!

  23. Clinical Indications for laparotomy in BAT Unstable VS, strongly suggestive abdominal injures Unequivocal peritoneal irritation Evidence of diaphragmatic injury Significant GI bleeding

  24. BAT Yes Clinical Indication for laparotomy No Hemodynamically Unstable? Yes IPH? +ve FAST / DPL IP injury? Source of bleeding? Laparotomy CT scan, FAST, DPL Observe

  25. BAT Clinical Indication for laparotomy No Hemodynamically Unstable? No IPH? IP injury? Other serious injuries Reliable exam Abdominal tenderness

  26. Case 1 50 yo M rolled his dump truck while intoxicated Prolonged extrication – 2 hrs+ Intubated for low GCS, STARS to FMC

  27. 78/48; 125; SaO2 96% 100%FiO2; temp 36.4; FAST indeterminite VBG pH 7.26, hbg90, lactate 3.5 ↑ PTT/INR, low plts

  28. DPA / PDL negative

  29. No intra-abdominal hemorrhage, no hemothorax Massive bleeding, exanguinating hematoma posterior torso.

  30. Transfused copious amounts blood products To interventional radiology Arrests, dies on table

  31. Case 2 35 yo roofer falls of a 12 ft roof at work. 2min LOC, confused and disoriented, GCS 13 (E3V4M6).

  32. 90 palp; HR 86; SaO2 100%2L; RR 18; temp 36.9 abdomen firm, mildly tender LUQ

  33. Embolization by interventional radiology Stabilises, no further transfusions Unit 71, discharged a few days later

  34. Case 3 4 yo F jumped out 2 story window No VS abnormalities Obviously deformed right femur No abdominal tenderness

  35. Insert XR here

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