Equivocal abdominal exam ongoing blood loss hematuria prolonged operation for other injuries immediate operation peritonitis on exam hypotension with. Evaluation of gastrointestinal injury in blunt abdominal trauma. Prophylactic antibiotic use in penetrating abdominal trauma. Pdf optimum methods for keeping the abdomen open researchgate. Pertrochanteric fractures of proximal femur are common traumas and internal fixation using a tubeplate with dynamic or intramedullary screw is a standard recognized treatment. Intraabdominal bleeding vascular injury or solid organ rupture 2. Since 19 th century, intraabdominal hypertension iah and abdominal compartment syndrome acs have been recognized. Abdominal trauma is responsible for about 10% of all deaths related to trama. Em006 penetrating abdominal trauma assessment life threatening consequences of penetrating abdominal trauma 1.
Methods during a 1year period, all awake and alert blunt trauma patients with glasgow coma scale gcs score of 14 or 15 were entered into a prospective study. The ntdb committee would like to thank all of the trauma centers that contributed data and hopes that this report will attract new participants. Pdf on jan 1, 2012, h morales uribe carlos and others published laparoscopia en. To characterize abdominal trauma treated at multiperfil clinic in luanda. Multidetector ct of blunt abdominal trauma radiology. The validity of abdominal examination in blunt trauma. This is a recommended management algorithm from the western trauma association addressing the. Diagnostic tools that help the treating doctor in optimum management of blunt abdominal trauma include.
Blunt abdominal trauma can cause severe damage to the spleen, liver, gallbladder, stomach, appendix, and intestines, which in turn can cause disease or death. The panscan computed tomographic ct examination of the head, neck, chest, abdomen, and pelvis has become an essential element in the early evaluation and decisionmaking algorithm for hemodynamically stable patients who sustained abdominal trauma. Yet the serial abdominal exam is a key part of the management of many clinical issues, for both trauma patients as well as those with acute care surgical problems. Abdominal clinical examination was performed and documented prospectively on all patients. Physical examination revealed a large, palpable, rightsided abdominal wall haematoma 35 25cm fig. Risk factors for mortality in blunt abdominal trauma with. Extensive soft tissue gas detecting superiorly from the facial planes in both thighs into the adductor fat planes in the anterior abdominal wall, likely related to the open femoral injuries. Pediatric blunt abdominal trauma emergency medicine. Penetrating injuries often result in injury to hollow organs, such as the intestines. Management guidelines for penetrating abdominal trauma walter l. An eastern association for the surgery of trauma practice management guideline. Trauma meded page 1 the trauma professionals blog trauma meded emphasis. He was otherwise fit and well with an unremarkable previous medical history.
From the division of trauma, critical care, and emergency general surgery. Early abdominal closure improves longterm outcomes after. Blunt abdominal trauma guidelines for diagnosis and treatment. Pediatric blunt abdominal trauma stephen wegner, mda,t, james e. Lateral decubitus axr should be considered to evaluate for. Diagnosis of blunt abdominal trauma is a real challenge even for experienced trauma surgeons.
North american journal of medical sciences march 2012 volume 4 issue. Intrauma today today, intrauma is the second largest supplier of trauma devices in italy, and is rapidly expanding its international sales and marketing operations across the world. The annual report of the national trauma data bank ntdb is an updated analysis of the largest. Penetrating abdominal trauma pat has the potential to be a.
Our final study population of 34 survivors prospectively completed a standardized study questionnaire, the sf36 health survey, and. Dpl or ultrasound evisceration open pelvic fracture anterior stab wound 4 gunshot wound ultrasound or ct ultrasound or dpl 2. Of the remaining 93 survivors, 59 were unreachable and not present in the social security death index. Penetrating abdominal trauma pat has the potential to be a devastating injury and ranks in the top 15 causes of death for all ages. In recent years, risk factors including gender, the time interval between injury and abdominal surgery, shock upon admission and head trauma were revealed5. Evaluation of abdominal trauma american college of. Multidetector ct of blunt abdominal trauma rsna publications. There is a lack of data in the literature related to. Prevalence and diagnosis rate of intraabdominal hypertension. Surgical management of abdominal trauma howard b seim iii, dvm, dacvs colorado state university if you would like a copy of the illustrated version of these notes on cd and a video of this surgical procedure on dvd, go to. Management of expanding lateral abdominal wall haematoma.
Penetrating injuries include gunshot and shrapnel injuries, impalements, and knifings. The approach to penetrating abdominal trauma 20120701 ahc. Wounds september 2012 inside this issue 1 when can you close that stab wound. Serie monografica manejo inicial del politraumatismo. These findings are pertinent in awake patients as well, but the. The morbidity, mortality, and economic costs resulting from trauma in general, and blunt abdominal trauma in particular, are substantial.
The signs and symptoms may include abdominal pain, tenderness, rigidity. Debate remains regarding the optimum role of laparoscopy in the setting of trauma although it can offer advantages over traditional exploratory laparotomy. Journal of trauma and acute care surgery, 773, 427432. It develops as a consequence of increased intraabdominal pressure iap not only in abdominal trauma, but also in intestinal obstructions with serous. There is a lack of data in the literature related to blunt abdominal trauma that required. A total of 108 patients survived their hospitalization, and 15 died following discharge. Abdominal trauma ppt major trauma medical specialties. Also, failure to diagnose abdominal wall trauma can result in misdiagnosis or delayed complications, which may necessitate a more complicated repair 57. Ldct protocols have achieved doses as low as the dose of two or three abdominal radiograph series 30,32,39 and more recently alshamari et al achieved an effective ldct dose of 1. Seram 2012 s1062 afectaciones viscerales en traumatismo.
Caracteristicas epidemiologicas del trauma abdominal en. To investigate the prevalence and diagnosis rate of intra abdominal hypertension iah in a mixedpopulation intensive care unit icu, and to investigate the knowledge of icu staff regarding the guidelines published by the world society of abdominal compartment syndrome wsacs in 20. Trauma abdominal cerrado y penetrante con lesion a organos. Intra abdominal bleeding vascular injury or solid organ rupture 2. Study of the occurrence of intraabdominal hypertension.
In mexico, abdominal trauma represents an important cause of morbidity and mortality, especially in young patients. Acs has been indicated as a complication in serious blunt abdominal trauma bat for more than 50 years. Abdominal trauma may involve penetrating or blunt injuries. The national trauma data bank annual report is available on the acs website as a powerpoint pdf at in addition, information is available on our. It was reported that iah could cause tissue and organ hypoperfusion and even lead to organ dysfunction. The approach to penetrating abdominal trauma 20120701.
The management of penetrating abdominal trauma by diagnostic. Therapeutic laparotomy required surgical treatment of organ injury. Intra abdominal pressure iap measurements have been identified as essential for diagnosis and management of both intra abdominal hypertension iah and abdominal compartment syndrome acs. Laparoscopy can be a screening, diagnostic or therapeutic tool in trauma. In the radiologic evaluation of abdominal pain after nonpenetrating trauma, additional diagnostic considerations include inguinal disruption. A repeat ct scan may show a change in the volume of fluid, or a change in its character. Pdf abdominal trauma is a major public health problem for all. Role of laparoscopy in penetrating abdominal trauma.
Blunt abdominal trauma in children schonfeld and lee. Diaphragmatic injury early surgical referral penetrating injury to the abdomen and abdomen with any of the following. Base excess is the quantity of base hco3, in meql that is above or below the normal range in the body. A negative number is called a base deficit and indicates metabolic acidosis. Colletti, mdb, donald van wie, doc aemergency medical services, blackfeet community hospital, po box 760, browning, mt 59417, usa bemergency medicine regions hospital, 640 jackson street, st. The validity of abdominal examination in blunt trauma patien. Third, despite the helpfulness of the first two factors, a negative examination and absence of comorbid injuries do not totally rule out an iai. Evaluation and management of blunt abdominal trauma.
Sep 29, 2012 debate remains regarding the optimum role of laparoscopy in the setting of trauma although it can offer advantages over traditional exploratory laparotomy. Las condiciones mas frecuentemente relacionadas con trauma abdominal cerrado son. Dec 16, 2015 yet the serial abdominal exam is a key part of the management of many clinical issues, for both trauma patients as well as those with acute care surgical problems. The management of penetrating abdominal trauma by diagnostic laparoscopy therapeutic laparotomy found organ injury that did not require intervention. Data collection and statistical analysis data extracted for analysis included demographic. Penetrating wounds 3 dealing with shotgun wounds 3 determining the age of bruises 4 hypothermia and wound infection in trauma. Pdf incidence, patterns, and factors predicting mortality of. Focussed assessment sonograph trauma fast and ct scan in. Being one of the referral hospitals, for trauma, we received a total figure of 6149 trauma victims out of which 500 were purely of abdominal in nature managed by the department of surgery. Early abdominal closure improves longterm outcomes after da.
Paul, mn 551012502, usa cdivision of emergency medicine, department of surgery, department of pediatrics. Obviously, there are some parts of the body where this cannot be. Intrauma is also dedicated to building and maintaining strong customer relationships, believing that this is the foundation of a successful business. Focal right lower renal pole poorly defined cortical hypodensity, possibly a blunt renal contusion. Cheryl pirozzi, md fellows conference 5411 abdominal trauma penetrating abdominal trauma stabbing 3x more common than firearm wounds gsw cause 90% of the deaths most commonly injured organs. Evaluation of abdominal trauma american college of surgeons. Study of the occurrence of intraabdominal hypertension and. Since kron et al 1 first reported intraabdominal hypertension iah in a clinical report, researches have increasingly been conducted on iahabdominal compartment syndrome acs. This entails making the hole bigger with a knife, and using surgical instruments and your eyes to find the bottom of the tract. Focussed assessment sonography for trauma fast, diagnostic peritoneal lavage dpl and ct scan. Management guidelines for penetrating abdominal trauma. If the amount of fluid increases significantly, or if a fluid bilayer is seen, a bucket handle injury is very likely. Second, in addition to the abdominal examination, other associated comorbid injuries or factors predict abdominal injury.
This poster was originally presented at the seram 2012 meeting, may 2428, in granadaes. As an examiner, you need to be able to determine if your patient is getting worse. Flat or low volume ivc consistent with volume depletion. Evaluation and management of abdominal stab wounds.