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APPROACH TO ABDOMINAL TRAUMA

APPROACH TO ABDOMINAL TRAUMA. DR.MOHAMMADZADEH. TRAUMA. Trauma is the most common cause of death for ages of 1 & 44 years. MECHANISMS OF INJURY. BLUNT TRAUMA PENETRATING TRAUMA. BLUNT TRAUMA. Low - energy transfer : struck with a club falling from a bicycle

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APPROACH TO ABDOMINAL TRAUMA

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  1. APPROACH TOABDOMINALTRAUMA DR.MOHAMMADZADEH

  2. TRAUMA • Trauma is the most common cause of death for ages of 1 & 44 years

  3. MECHANISMS OF INJURY • BLUNT TRAUMA • PENETRATING TRAUMA

  4. BLUNT TRAUMA • Low - energy transfer : • struck with a club • falling from a bicycle • falls from short height • High-energy transfer : • auto-pedstrain accident • motor vehicle accident • motor-cycle accident • falls from heights greater than 20 feet

  5. PENETRATING TRAUMA • Stab wound • Gunshot wounds • high-velocity injury(bullet speed > 2000 ft/s ) • low-velocity injury • Shotgun wounds • close-range (< 7meters ) • long-range ( > 7 meters )

  6. DIAGNOSTIC PERITONEALLAVAGE DPL • The most sensitive test for determining of intraabdominal injury • POSITIVE TEST • Aspiration of more than 10 ml of free blood • RBC greater than 100,000/ml • Detection of bile, vegetable or fecal materia • ALK.PH>3IU/L & Amylase> 20 IU/L • Effluent draining from a chest tube,NGT,Fo

  7. INDICATION OF DPL • Equivocal physical exam • Unexplained shock or hypotention • Altered sensorium(e.g closed-head injury) • General anesthesia for extra abdominal proc • Cord injury

  8. ADVANTAGES OFULTRASOUND • Noninvasive • Dose not require radiation • Useful in the resucitation room or emergency department • Can be repeated • Used during initial evaluation • Low cost

  9. DISADVANTAGES OFULTRASOUND • Examiner dependent • Obesity • Gas interposition • Lower sensitivity for the fluid <500 ml • False-negative retroperitoneal and hollow viscus injuries

  10. ADVANTAGES OF CT-SCAN • Adequate assesment of the retroperitoneum • Nonoperative measurment of solid organ injuries • Assesment of renal perfusion • Noninvasive • High specifity

  11. DISADVENTAGES OF CT-SCAN • Specialized personnel • Hardware • Duration: helical versus conventional • Hollow viscus injuries • Cost

  12. INDICATION OF CT-SCAN • Blunt trauma • Hemodynamic stability • Normal or unreliable physical examination • Mechanism : duodenal and pancreatic trauma

  13. CONTRAINDICATION OF CT-SCAN • Clear indication for exploratory laparotomy • Hemodynamic instability • Agitation • Allergy to cotrast media

  14. DECISION MAKING FOR BLUNTABDOMINAL TRAUMA Overt peritonitis Hemoperitoneum LAPARATOMY

  15. HIGH-ENERGY TRANSFER DPL POSITIVE NEGATIVE LAPAROTOMY OBSERVE

  16. LOW-ENERGY TRANSFER stable v/s Unstable v/s CT-SCAN DPL Major solid organ Hollow viscus Minor solid organ LAPAROTOMY OBSERVE

  17. STAB WOUND TO LOWERCHEST AREA Exploration of wound for diaphragmatic - injury DPL - Thoracoscopy -

  18. STAB WOUND TO ANTERIORABDOMEN Fascia intact D/C HOME Local wound exploration Negative Observation Fascia violated DPL Positive Laparotomy

  19. STAB WOUND TO BACKAND FLANK Frequent examination DPL Triple contrast CT -scan

  20. GUNSHOT WOUNDS Peritoneal violation Laparotomy Positive Gunshot wounds Equivocal DPL Negative Superficial Observe

  21. SHOTGUN WOUND Close-range Similar to gunshot Shotgun wound Long-range Abdominal X-ray AP and lateral

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