Abdominal

Trauma
Oleh :

Dr. A. Aziz, Sp.B-KBD

Disajikan pada Pelatihan Penanggulangan Penderita Gawat

Darurat (PPGD) RSD Raden Mattaher Jambi tanggal 28 November
2005 s/d 04 Desember 2005
Objectives
Describe external and internal anatomy

Recognize blunt vs penetrating injury

Patterns
Indentify signs different types of
injuries
Apply diagnostic and therapeuti
Procedures

Demonstrate and discuss DPL

Abdominal Trauma

Unrecognized injury : Cause of
preventable death

Exam compromised by
Alcohol, illicit drugs
Injury to brain, spinal cord
Injury to ribs, spine, pelvis
Anatomy

External

Anterior abdomen

Flank

Back
Anatomy
Mechanism of injury

Blunt

Spleen, liver, and Hollow
viscus

Compression

Crushing

Shearing

Deceleration (fixed organs)
Mechanism of injury
Penetrating

Liver , small bowel, and colon

Laceration / low energy

Kinetic energy / high energy
Assessment : History
Blunt Penetratin

Speed g

Point of impact
Weapon

Intrusion
Distance

Safety devices

Position

Ejection
Assessment : Physical Exam
Inspection
Percussion
Palpation
Auscultation
Assessment : Physical Exam

Local wound exploration by surgeon

Pain over bony pelvis

Genitourinary, perineal,
rectal,vaginal

and gluteal
Adjuncts : Intubation
Gastric Tube
Relieves dilatation

Decompresses stomach before

DPL

Basilar skull/facial fractures

My induce vomiting/
aspiration
Adjuncts : Intubation
Urinary Catheter

Monitors urinary output

Decompresses bladder before DPL

Diagnostic

Urethral injury
Adjuncts : x ray Studies
Routine

Blunt : AP chest, pelvis

Penetrating : AP chest, abdomen
with
markers (if hemodynamically
normal)
Contrast GI

Urethrogram IVP

Cystogram
 Special Studies in Blunt Trauma
DPL US* CT
Time Rapid Rapid Delayed
Transport No No Required
Sensitivity High High? High
Specificity Low Intermedia High
te
Eligibility All All patients Hemodyna
patients mically
normal
Indications for Celiotomy
Blunt Penetrating

+ DPL or

+ DPL or ultrasound

ultrasound
Peritoneal/
retroperitoneal

BP suspected
injury
visceral injury
Peritonitis

Peritonitis
Hypotension

Evisceration
Indications for Celiotomy
Plain X ray
Free air
Retroperitoneal air
Ruptured diaphragm
Indications for Celiotomy
Special Studies
CT scan : Free air, visceral injury ?
Fluid?
Cystogram : Bladder rupture,
intraperitoneal injury
Arteriogram: Renal pedicle occlusion
Upper GI : Duodenal rupture
Special Problems : Blunt
Trauma
Diaphragm : Abnormal chest x ray
Duodenum/ Retroperitoneal air,
contrast
small bowel :
seat belt sign, chance
fracture ,free air
Pancreas : Amylase ?, CT ?
GU : Extravasation of contras
nonfunctioning renal
Pelvic Fractures
Significant force
applied
Associated injuries
Pelvic bleeding
Ends of bones
Pelvic muscles
Veins/arteries
Pelvic Fractures
Mechanism Classification

Ap compression
Open

Lateral
Closed
compression

Vertical shear
Pelvic Fractures
Assessment

Inspection

Palpate prostate

Pelpiv ring
Leg-length disrepancy , external
rotation
Pain on palpation of bony pelvic ring
AP x - ray
Pelvic Fractures :
Management Resuscitate

Transfer as needed with PASG

Determine if intraperitoneal hermorrhage

Operation
Control hemorrhage Fixation device

Possible angiography
Questions

?
Summary

ABCDEs

Delineate mechanism

Repeated exams

Diagnostics as needed

High index of suspicion

Early recognition /prompt
celiotomy