Although abdominal trauma has been described since antiquity, formal laparotomies. The mechanism of injury dictates the diagnostic workup. Abdominal trauma cdr john p wei, usn mc md 4th medical battalion, 4th mlg bsrf12 abdominal trauma blunt abdominal trauma solid organ injuries including liver, spleen, kidneys, pancreas rupture of hollow viscus including small and large intestine, stomach, esophagus, and bladder vascular injuries bony fractures of pelvis and lumbar spine penetrating abdominal trauma. Pdf on sep 20, 2017, alabousi a and others published blunt abdominal trauma. Providing traumainformed care curbside consultation. Evaluation of abdominal trauma differential diagnosis of. The nature and severity of abdominal injuries vary widely depending on the mechanism and forces involved, thus generalizations about mortality and need for. Blunt abdominal injuries often managed conservatively, though interventional radiology and surgery are indicated for severe injuries. Abdominal trauma is classified as blunt or penetrating, assessment and management is modified accordingly. Abdominal trauma the equine acute abdomen wiley online. Cullens sign, grey turner sign and distension can be a late sign and difficult to determine.
The use of the fast examination is not limited to trauma but is best described in studies involving adults who sustained blunt or. A negative urinalysis is associated with a low likelihood of intraabdominal injury after blunt abdominal trauma. International journal of scientific study july 2017 vol 5 issue 4. Prior to fast, invasive procedures such as diagnostic peritoneal lavage and exploratory laparotomy were commonly utilized to diagnose intraabdominal injury.
Intraabdominal hypertension, abdominal compartment. Effect of abdominal ultrasound on clinical care, outcomes, and resource use among children with blunt torso trauma. Family physicians commonly care for survivors of trauma, but they may not always realize it. Abdominal injuries may be life threatening and should be approached cautiously.
Assault and other forms of domestic blunt trauma contributed to the rest 21% of the cases. Complications may include blood loss and infection diagnosis may involve ultrasonography, computed tomography, and peritoneal lavage, and treatment may involve surgery. Orlando catalano, in clinical ultrasound third edition, 2011. Early management of severe abdominal trauma sciencedirect.
Focused assessment with sonography in trauma fast has been extensively utilized and studied in blunt and penetrating trauma for the past 3 decades. Penetrating injuries include gunshot and shrapnel injuries, impalements, and knifings. The focused assessment with sonography for trauma fast examination is conducted to rapidly identify bleeding within the abdominal, pericardial, or intrathoracic spaces. Introduction abdominal trauma means any injury occurring to abdominal cavity. Blunt abdominal trauma evaluation and management guideline adult practice management guideline effective. As there is a broad spectrum of abdominal injuries, abdominal trauma patients are often difficult to assess. Introduction abdominal trauma is regularly encountered in the emergency department one of the leading cause of death and disability identification of serious intraabdominal injuries is often challenging many injuries may. Hollow viscera injuries are less than 1%, however its. Department of clinical sciences, college of veterinary medicine, north carolina state university, raleigh, north carolina, usa. The abdomen can be injured in many types of trauma. Appreciate the necessity for emergent surgical intervention in certain abdominal trauma conditions.
Dpl or ultrasound evisceration open pelvic fracture anterior stab wound 4 gunshot wound ultrasound or ct ultrasound or dpl 2. As there is a broad spectrum of abdominal injuries, abdom. The penetrating abdominal trauma index pati was developed in 1979 6 as a result of the inadequacies of iss to assist in clinical investigation of penetrating wounds, and was subsequently modified to the abdominal trauma index ati 7. Blunt abdominal injury the eastern association for the. Assessment of abdominal trauma differential diagnosis of. A 24yearold man was brought to the emergency department after a highspeed motor vehicle collision. Identification of an abdominal injury begin with the initial assessment conducted using emst principles including adjuncts3.
Nonoperative management is employed in over 95% of patients. Common causes of abdominal injury include blunt trauma motor vehicle accidents mvas and falls, and penetrating trauma gunshot wounds gsws and stabbings. Background information abdominal trauma in pregnancy may lead to. Pediatric abdominal trauma is typically blunt in nature with the spleen being the most common organ injured.
In this case, the organs most affected are the small intestine, colon. Us was first utilized for the examination of trauma patients in the 1970s in europe 2, 3. Lal ms associate professor department of surgery esi pgimsr new delhi 2. The signs and symptoms may include abdominal pain, tenderness, rigidity.
Focused assessment with sonography in trauma fast in 2017. According to the world health organization who, trauma will become the first or second leading cause of loss of productive years of life for both developed and. Cervical spine injuries pdf trauma team activation criteria pdf geriatric trauma care guideline pdf geriatric trauma management guidelines, american college of surgeons trauma quality improvement program, revised april 2015 pdf head injury in anticoagulated patients pdf evaluation and management of blunt abdominal trauma pdf. In a randomized clinical trial rct of the focused assessment with sonography for trauma fast examination in stable children with blunt abdominal trauma compared with standard evaluation, dr holmes and colleagues1 found no difference in coprimary outcomes, including computed. It is divided into two types blunt or penetrating and may involve damage to.
Abdominal injuries are found in 2030% of patients with multiorgan injuries. Abdominal trauma blunt trauma causes the majority of abdominal injuries in children rtc recreational activities o contact sports o bicycle or scooter handlebar injuries o horse riding o fall from a height a high index of suspicion is necessary to ensure abdominal trauma is not missed. Abdominal penetrating trauma an overview sciencedirect topics. Trauma center practice management guideline blank childrens hospital des moines blunt abdominal trauma evaluation and management guideline pediatric practice management guideline effective. An audit of management of cases of blunt trauma abdomen. Management guidelines for penetrating abdominal trauma.
Division of trauma, surgical critical care, burns and. Patterns and outcomes of patients with abdominal trauma on. In civilian life, the majority of abdominal injuries are due to blunt trauma secondary to high speed automobile accident. Penetrating abdominal trauma is usually the result of stab or gunshot wounds. Abdominal trauma remains a leading cause of mortality in all age groups.
Equivocal abdominal exam ongoing blood loss hematuria prolonged operation for other injuries immediate operation peritonitis on exam hypotension with. To address the evaluation of patients presenting after blunt abdominal trauma. Share suggestions for new or updated guidelines and proposals although east membership not a prerequisite to coauthoring a pmg, east typically reserves the use of noneast members for those with specific expertise i. Abdominal tenderness and clinical evidence of blunt abdominal trauma evidence of a head injury low or fluctuating gcs. Evaluation of abdominal trauma american college of surgeons. A variety of trauma patterns may arise, depending on the type, entrance site, direction and penetration depth of the traumatic agent. Focused assessment with sonography in trauma richards and mcgahan splenic injury from blunt abdominal trauma as 80% four of five 3. Abdominal trauma is best categorized by mechanism as blunt or penetrating abdominal injury. The role and limitations of serial abdominal examination in the assessment of a blunt abdominal trauma patient needs to be determined on a casebycase basis. Abdominal trauma is responsible for about 10% of all deaths related to trama. Overview of abdominal trauma msd manual professional edition. Background a carefully performed physical exam, while being cognizant of the. Holmes jf, kelley km, woottongorges sl, utter gh, abramson lp, rose js, tancredi dj, kuppermann n. Patients with abdominal trauma should have rapid assessment, stabilization, and early surgical consultation to maximize the chances of a successful outcome.
Abdominal penetrating trauma an overview sciencedirect. Trauma center practice management guideline iowa methodist. If your patient has lumbar vertebral fractures, assess him for. Signs and symptoms include abdominal pain, tenderness, rigidity, and bruising of the external abdomen. Trauma, education and training, education, ct, emergency, abdomen. Blunt abdominal trauma the royal melbourne hospital. Abdominal trauma may involve penetrating or blunt injuries. Shoulder tip pain kehrs sign significant abdominal injuries may present with little external evidence of trauma or a trivial pattern of injury and or mechanism. Patients with open or penetrating abdominal trauma are usually subjected to exploratory laparotomy, however, in selected cases, many surgeons decide not to operate and keep their patients under observation since this expectant. Blunt abdominal trauma 5758 blunt splenic trauma 5960 blunt bowel and mesenteric injury 6162 rectal injury 6364 pelvic fracture 6566. Common mechanisms include road traffic crashes, falls, sports injuries and assaults. Trauma is a physical injury caused by transfer of energy to and within the person involved. The majority of bat cases 75 percent are related to motor vehicle collision mvc or auto versus pedestrian accidents 2.
This clinical guideline on urotrama discusses diagnosis and management of genitourinary injuries, including renal, ureteral, bladder, urethral, and genital trauma. Blunt abdominal trauma bat accounts for the majority 80 percent of abdominal injuries seen in the emergency department, and is responsible for substantial morbidity and mortality. He was a restrained driver noted to be awake at the scene of the collision and had to be extracted from the vehicle. Hence, the modes of injuries which can lead to significant blunt abdominal trauma are varied.
Abdominal trauma is best categorised by mechanism as blunt or penetrating abdominal injury. Blunt abdominal injury bai is common and usually results from motor vehicle collisions mvc, falls and assaults. In this article, we present our experience with the management of abdominal trauma in durban and investigate factors that influence outcome. Multiple injuries in blunt abdominal trauma surgery. Division of trauma, surgical critical care, burns and acute.
Flank ecchymosis and broken ribs are signs suggestive of renal injury. Assessment of urinary dipstick in patients admitted to an ed for blunt abdominal trauma. After trauma, the abdomen may be sanctuary for occult bleeding that, if not discovered and corrected expeditiously, may lead to deleterious consequences. Focused assessment with sonography in trauma fast in. V2 endorsed by the advisory committee on trauma august 2017. Trauma wound care and infection control mayo clinic. The ati was based on 1 the individual organ severity and 2 the relative risk of early morbidity and mortality estimated for each organ. Trauma is the leading cause of death in pediatric patients older than 1 year, with abdominal trauma accounting for 10% of causes of death. Abdominal trauma in a semiurban tertiary health institution. It was not widely adopted in north america until the 1990s, during which time the fast acronym was defined as focused abdominal sonography for trauma 4 6. Blunt abdominal trauma bat comprises 75% of all blunt trauma and is the most common example of this injury. As there is a broad spectrum of abdominal injuries, abdo. Civilian renal injury occurs in up to 5% of trauma victims, 10, 11 and accounts for 24% of traumatic abdominal solid organ injuries.
Blunt abdominal trauma is the leading cause of intraabdominal injury with motor vehicle accidents being the leading. Emergency repair of complicated abdominal wall hernias. Urotrauma guideline 2017 american urological association. Pediatric trauma guidelines page pediatric blunt spleenliver trauma management 1 pediatric blunt renal trauma management 23. Spleen was the most common organ 66% involved followed by liver 38%. Discuss the eventual disposition of abdominal trauma patients based on their diagnosis. List 5 ways to determine if peritoneum has been violated 7 list clinical indications for laparotomy in blunt and penetrating abdominal trauma 8 describe the management of unstable blunt abdominal trauma a. Trauma, which can affect any patient regardless of age or. Intraabdominal hypertension, abdominal compartment syndrome, and the open abdomen william kirke rogers, md. The division was designed to respond to any emergency call 247 with fully equipped stateofthe art trauma bays. Penetrating injuries often result in injury to hollow organs, such as the intestines.
Whether a trauma or a burn victim, they will be seen by a multidisciplinary team of specialists. Abdominal trauma is seen quite often in the emergency department and can result from blunt or penetrating mechanisms. Abdominal trauma blunt trauma causes the majority of abdominal injuries in children rtc recreational activities o contact sports o bicycle or scooter handlebar injuries o horse riding o fall from a height a high index of suspicion is necessary to ensure abdominal trauma is not. 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. The fast examination for children with abdominal trauma. Chapter 10 does ct scan for blunt abdominal trauma in children.
Abdominal injury as a result of both blunt and penetrating trauma has an appreciable mortality rate from hemorrhage and sepsis. Complications may include blood loss and infection. Abdominal trauma is present in approximately 25% of pediatric patients with major trauma and is the most common cause of unrecognized fatal injury in children. Through better understanding of blunt abdominal trauma and advancements in diagnostics. Common abdominal organ injuries involve the liver, spleen, kidneys, intestines and vasculature. Factors that may warrant laparotomy for a patient undergoing serial abdominal examination for blunt abdominal trauma, include worsening abdominal exam, increasing wbc, decreasing. He was hemodynamically stable on route to the hospital.
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