27 y.o. female involved in a one vehicle roll-over MVC. Pt. was ejected and found unconscious at the scene. She was intubated and flown to the emergency departmentin full c-spine precautions • Pt. has multiple abrasions and lacerations on abdomen, flank and chest • Abdomen is firm and slightly distended. • V/S: B/P 80/40 (after 2 L N/S) HR: 124 RR: 18 (On vent.) Temp: 37 • What is the best way to diagnose an intra-abdominal bleed in this patient?
DPL • A rapid technique of diagnosis of intra-abdominal bleeding by the instillation of IVF into the abdominal cavity. • Considered positive with; • Frank blood upon entry. • 100,000 RBC per cc. • 500 WBC per cc. • Positive gram stain for food fiber/bacteria.
DPL indications • For rapid evaluation of the unstable patient. • Blunt abdominal trauma • MVC • Falls • Penetrating abdominal trauma • Best for stabbings of unknown depth • Not usually indicated for GSW
Relative Contraindications • Pregnancy • Previous abdominal surgeries • Morbid obesity • Coagulopathy Only absolute is known need for laparotomy.
DPL Technique • Insertion of Foley catheter. • Insertion of orogastric or nasogastric tube • Modified Seldinger technique of catheter placement. • Instillation of warm IVF. • Gravity drainage of fluid.
How good is it? • DPL(sensitivity--95.9%, specificity--99%, accuracy--98.2%). • CT(sensitivity--74.3%, specificity--99.5%, accuracy--92.6%). • Evaluation of computed tomography and diagnostic peritoneal lavage in blunt abdominal trauma. J Trauma. 1989 Aug;29(8):1168-70;
Limitations • Will not be positive on retroperitoneal bleeding, unless peritoneum is disrupted.