Ø
Mechanism of Injury:
²
Blunt Trauma:
*
Spleen, liver, retroperitoneal
hematoma
²
Penetrating Trauma:
*
Stab: Liver, small bowel, diaphragm,
colon
*
Gunshot: small bowel, colon, liver,
abdominal vascular structures.
Ø
Assessment:
²
Hitory.
²
PE:
*
Inspection
*
Auscultation:
1. Bowel sounds
*
Percussion
1. signs of peritonitis
2. Tympanic/ diffuse dullness
*
Palpation
1. Involuntary muscle guarding
*
Evaluation of penetrating wounds:
Determine the depth
*
Assessing pelvic stability:
Manual compression
*
Penile, perineal and rectal examination:
1. Presence of urethral tear.
2. Rectal exam: Blunt (sphincter tone, position of the prostate, pelvic bone fractures), Penetration (sphincter tone, gross blood from a perforation)
*
Vaginal examination
*
Gluteal examination
² Intubation:
* Gastric tube:
! Relieve acute gastric dilatation.
! Presence of blood
*
Urinary catheter:
!
Relieve urine retention
!
Monitoring urine output.
!
Caution: The inability to void, unstable
pelvic fracture,blood in the meatus, a scrotal hematoma, perineal ecchymoses,
high-riding prostate.
²
X-rays studies:
*
Blunt Trauma:
! Hemodynamically stable:
Supine/upright abdominal x-rays
Left lateral decubitus film
*
Penetrating Trauma:
!
Hemodynamically stable:
Upright CXR.
²
Contrast Studies:
*
Urethrography
*
Cystogaphy
*
IVP
*
GI series
²
Special diagnostic studies in blunt trauma:
*
DPL
*
Ultrsonography
*
Computed tomography
²
Special diagnostic studies in penetrating trauma:
*
Lower chest wounds
*
Anterior abdominal
*
Flank/back
Ø
Indications For Celiotomy
²
Based on abdominal evaluation
*
Blunt: Positive DPL/ ultrasound
*
Blunt: Recurrent hypotension despite
adequate resuscitation
*
Peritonitis
*
Penetrating: Hypotension
*
Penetrating: Bleeding from the stomach,
rectum, GU tract.
*
Gunshot wounds: Traversing the
peritoneal cavity
*
Evisceration
²
Based on x-rays studies:
* Free air, retroperitoneal free air, rupture of the hemidiaphragm
* CT demonstrates ruptured organ/ GI tract.
Ø
Special Problems
²
Blunt Trauma:
*
Diaphragm
*
Duodemun
*
Pancrease
*
Genitourinary
*
Small bowel
²
Pelvic Fractures:
*
Assessment:
!
The flank, scrotum and perianl area
should be inspected
!
Blood at the urethral meatus,
swelling/bruishing/laceration in the peritoneum, vagina, rectum, or buttock Ô open pelvic facture
!
Palpation of a high-riding prostate
gland.
!
Manual manipulation of the pelvis
should be performed only once.