Abdominal Trauma in the Major Trauma Victim

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#CC9900" TEXT="#080000" bgproperties="fixed" background="044005a0dwnjzk.png"> <div> <A HREF="index.htm" TARGET="_top" TITLE="TRAUMA SURGERY"><U><B>home</B></U></A><B>     | </B><B> </B><B> </B><B>  </B><FONT SIZE="5" COLOR="#FFCC66" FACE="Arial" ><B>TRAUMA SURGERY</B></FONT></div> <div> <A HREF="id19.htm" TARGET="_top" TITLE="compartment syndrome"><U><B>compartment syndrome</B></U></A><B>   |   </B><A HREF="id27.htm" TARGET="_top" TITLE="fasciotomy"><U><B>fasciotomy</B></U></A><B>   |   </B><A HREF="id28.htm" TARGET="_top" TITLE="Heel Spur Syndrome"><U><B>Heel Spur Syndrome</B></U></A><B>   |   </B><A HREF="id21.htm" TARGET="_top" TITLE="trauma management"><U><B>trauma management</B></U></A><B>   |   </B><A HREF="id22.htm" TARGET="_top" TITLE="Neck Trauma"><U><B>Neck Trauma</B></U></A><B>   |   </B><A HREF="id23.htm" TARGET="_top" TITLE="Chest Trauma"><U><B>Chest Trauma</B></U></A><B>   |   </B><B>Abdominal Trauma in the Major Trauma Victim</B><B>   |   </B><A HREF="id25.htm" TARGET="_top" TITLE="Extremity Trauma"><U><B>Extremity Trauma</B></U></A><B>   |   </B><A HREF="id26.htm" TARGET="_top" TITLE="Airway Management and Rapid Sequence Int"><U><B>Airway Management and Rapid Sequence Intubation (RSI)</B></U></A><B>   |   </B><A HREF="id20.htm" TARGET="_top" TITLE="pelvic fracture surgery"><U><B>pelvic fracture surgery</B></U></A><B>   |   </B><A HREF="id18.htm" TARGET="_top" TITLE="Contact Me"><U><B>Contact Me</B></U></A><B>   |   </B><A HREF="id17.htm" TARGET="_top" TITLE="Related Links"><U><B>Related Links</B></U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> Abdominal Trauma in the Major Trauma Victim</div> <bR> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> Abdominal Trauma in the Major Trauma Victim (including assault and abuse in children) </div> <div> <B>Diagnosis.</B> Possible intra-abdominal injury indicated by: </div> <div> Systolic blood pressure less than 100 or hematocrit <29. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">No criterion is absolute; so use clinical judgment. </div> <div> "Lap-belt ecchymosis" in children is associated with hollow organ injury, lumbar spine fracture, solid organ (liver/spleen) injury. </div> <div> Elevated ALT and AST may indicate liver injury. </div> <div> Physical exam only about 65% accurate. </div> <div> Associated with the presence of chest injuries. </div> <div> Associated with the presence of pelvic fractures. </div> <div> <B>Penetrating trauma</B> of the abdomen requires exploration if penetrates the peritoneum. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Some centers are doing CT only but not yet universally accepted as standard of care. </div> <div> <B>Blunt trauma of the abdomen.</B> </div> <div> If hemodynamically <B>unstable</B> and have acute abdomen, need laparotomy. Do not wait for CT or diagnostic peritoneal lavage (DPL) before consulting surgery. </div> <div> If hemodynamically <B>stable</B> and patient is complaining of abdominal pain or is intoxicated or head injured, or there is an associated injury noted above, proceed with CT or DPL. Both CT and DPL have strengths and weaknesses. </div> <bR> </td> </tr></table></body>