Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Objectives
Identify and apply the most appropriate
times new Roman 42, bold, shadow
Pelvic cavity
Abdominal Trauma
Unrecognized
intraabdominal
injury
Abdominal trauma priority?
It determines what
organs are probably
injured.
Blunt Force Mechanism
Spleen
Liver
Small bowel
Penetrating Mechanism?
Common injuries?
Low Energy High Energy
Liver Small bowel
Small bowel Colon
Diaphragm Liver
Colon Vascular structures
Assessment: History
Blunt Penetrating
Speed Weapon
Point of impact Distance
Intrusion Number of wounds
Safety devices
Position
Ejection
Assessment: Physical Exam
Inspection
Auscultation
Percussion
Palpation
Abdominal Trauma
Relieves distention
Decompresses stomach before DPL
Routine
Blunt: AP Chest and Pelvis
Penetrating: AP chest and abdomen
with markers (if hemodinamically
normal)
Adjuncts: Contrast Studies
Urethrogram
Cystogram
IVP
GI
Abdominal CT
Diagnostic Studies: Penetrating
Blunt Trauma
BP, suspect visceral injury
Free air
Diaphragmatic rupture
Peritonitis
+ DPL, FAST, or contrast CT
Indications for celiotomy?
Penetrating Trauma
Hypotension
Peritoneal / retroperitoneal injury
Peritonitis
Evisceration
+ DPL, FAST, or contrast CT
Remember
a missed abdominal
injury is a common
cause of a potentially
preventable death.
Pelvic Fractures
Mechanism
AP compression
Lateral
compression
Vertical shear
Pelvic Fractures
Classification
Open
Closed
Pelvic Fractures
Significant force
applied
Associated
injuries
Pelvic bleeding
Bone ends
Pelvic muscles Veins / arteries
Pelvic Fractures
Assessment
Inspection
Palpate prostate
Pelvic ring
Leg-length discrepancy, external rotation
Pain on palpation of bony pelvic ring
Pelvic Fractures
Emergency Management
Fluid resuscitation
Determine if open or closed fracture
Determine associated perineal / GU injuries
Determine need for transfer
Splint pelvic fracture
ABCDEs and early surgical consultation
Evaluation and management vary with a
mechanism and physiologic response
Repeated exams and diagnostic studies
High index of suspicion
Early recognition / prompt celiotomy