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Epigastric Stab Wounds

Epigastric Stab Wounds. An 11-year old male is brought to the ER 30 minutes after sustaining a stab wound at the epigastric area during a street rumble. . Epigastric Stab Wounds. At the Emergency Room: He is conversant, conscious, coherent, ambulatory, not in respiratory distress

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Epigastric Stab Wounds

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  1. Epigastric Stab Wounds

  2. An 11-year old male is brought to the ER 30 minutes after sustaining a stab wound at the epigastric area during a street rumble.

  3. Epigastric Stab Wounds At the Emergency Room: • He is conversant, conscious, coherent, ambulatory, not in respiratory distress • VS: BP 100/60, PR 82 bpm, RR 24 cpm, T 36.5 C • Pale palpebral conjunctivae, anicteric sclerae • Chest: symmetrical chest expansion with clear breath sounds • Heart: normal • Abdomen: flat, with a 1.5 x 1.5 cm stab wound at the epigastric area, hypoactive bowel sounds, soft, direct tenderness at the epigastric area • Rectal exam is unremarkable

  4. Presentation • Assessment begins at the scene of the incident and on the way to the emergency department • ABC’s of primary survey should be followed • Upon arrival at the emergency department, incident history and the patient’s vital is important • Patients who present with hypotension are already in class III shock (30-40% blood volume loss), and they should receive blood products as soon as possible • Physical examination includes inspection of all body surfaces, with notation of all penetrating wounds

  5. Presentation • In the examination of the abdomen, if there is peritoneal signs, such as pain and guarding and rebound tenderness, exploration without delay is a necessity • Presence of abdominal rigidity or gross abdominal distention is an indication for prompt surgical exploration • Rectal examination, as blood per rectum and high-riding prostate can indicate bowel injury and genitourinary tract injury, respectively • Notation of blood at the urethral meatus is also a sign of genitourinary tract injury

  6. Management of penetrating abdominal trauma. CT = computed tomography; DPL = diagnostic peritoneal lavage; RBC = red blood cells.

  7. Laboratory Studies • Complete blood count (CBC) • Basic chemistry profile (BMP) • Coagulation studies (PT/INR + PTT) • Arterial blood gas (ABG) • Urine dipstick • Blood Typing and Crossmatching • Ethanol and drug screens

  8. Imaging Studies • Plain radiograph • Ultrasound • CT Scan

  9. Diagnosis Nasogastric intubation - All patients undergoing endotracheal intubation require decompression of the stomach to decrease the risk of aspiration. Blood in the nasogastric tube can indicate upper gastrointestinal injury.

  10. Diagnosis Foley catheterization - required to monitor the fluid resuscitation status of the patient with penetrating abdominal trauma. The presence of blood in the urine is a sign of genitourinary tract injury

  11. Diagnosis Diagnostic peritoneal lavage - DPL sensitivity for detecting intraabdominal injury exceeds 95 % - Results of DPL: • grossly (+) – if >10 mL of free blood can be aspirated • if < 10 mL– a liter of normal saline is instilled and the effluent is sent to the laboratory for RBC count, amylase alkaline phosphatase, and bilirubinlevels and red blood cell count greater than 100,000/μLis considered positive

  12. Diagnosis CT Scan • specificity for hepatic, splenic, and renal injuries • indicated primarily for hemodynamically stable patients who are candidates for nonoperativetherapy

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