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Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

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Nội dung chi tiết: Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

Abdominal TraumaMatthew D. Neal, L.D. Britt, Greg Watson, Alan Murdock and Andrew B. PeitzmanI.Abdominal injuries arc divided into two broad categorie

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2es: Blunt and penetrating abdominal trauma, based on the mechanism of injury. Expedient diagnosis and treatment of intra abdominal injuries are essent

ial to avoid preventable morbidity and death. Since management guidelines are different for blunt and penetrating abdominal trauma, they will be discu Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

ssed separately.II.Blunt abdominal trauma. Common mechanisms include falls, motor vehicle crashes, motorcycle or bicycle crashes, sporting mishaps, an

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

d assaults.A.Inlraabdominal injuries result from:1Compression causing a crush injury2Abrupt shearing force causing tears of organs or vascular pedicle

Abdominal TraumaMatthew D. Neal, L.D. Britt, Greg Watson, Alan Murdock and Andrew B. PeitzmanI.Abdominal injuries arc divided into two broad categorie

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2jury is essential to determine the likelihood of an intraabdominal injury' (see chapter 22). Abdominal examination after blunt trauma is often unrelia

ble. Altered level of consciousness, spinal cord or other distracting injury, and medication or substance effects can further confound the physical ex Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

amination. Although adjunctive tests arc important in the evaluation of blunt abdominal trauma, careful, repealed physical examination of the patient

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

remains essential in the early diagnosis of abdominal injury. The choice of adjunctive diagnostic tests depends, in part, on rhe hemodynamic stability

Abdominal TraumaMatthew D. Neal, L.D. Britt, Greg Watson, Alan Murdock and Andrew B. PeitzmanI.Abdominal injuries arc divided into two broad categorie

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2o perform serial physical examinations reliably) (Fig. 29-1).ỉn the hemodynamically unstable patient or the patient with ongoing fluid requirements, r

apid evaluation of the abdomen while the patient is in the trauma resuscitation area is mandatory. Ultrasound (focused abdominal sonography for trauma Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

[FASTI), diagnostic peritoneal aspiration (DPA), or diagnostic peritoneal lavage (DPI,) arc appropriate diagnostic tools to determine the presence of

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

hemoperitoneum; in recent years, the safety and rapidity of surgeon-performed focused ultrasound have substantially diminished the role of DPL. bl th

Abdominal TraumaMatthew D. Neal, L.D. Britt, Greg Watson, Alan Murdock and Andrew B. PeitzmanI.Abdominal injuries arc divided into two broad categorie

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2Evaluation of the patient will often uncover signs of hypoperfusion (e.g., obtundation, cool skin temperature, mottling, diminished pulse volume, or d

elayed capillary refill), which should initiate a search for a source of blood loss. Factors associated with abdominal injury requiring laparotomy inc Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

lude chest injury, base deficit, pelvic fracture, or hypotension in the field or trauma resuscitation area.i.Evaluation of the abdomen may detect dist

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

ension or signs of peritoneal irritation (usually associated with injury to a hollow viscus). On the other hand, blood in the peritoneum often does no

Abdominal TraumaMatthew D. Neal, L.D. Britt, Greg Watson, Alan Murdock and Andrew B. PeitzmanI.Abdominal injuries arc divided into two broad categorie

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2abdominal trauma.Hemocynamically unstableChapter 29 • Abdominal Trauma I 359motor vehicle crash, particularly with a visible contusion on the abdomen

from a lap belt, or a lumbar vertebral body fracture (especially a Chance fracture), suspect hollow viscus injury, an injury commonly missed.2Diagnost Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

ic tests. The goal of rhe initial evaluation of the abdomen is to identify quickly rhe patient who requires laparotomy. Victims of blunt trauma with h

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

ypotension and abdominal distension or peritoneal signs should proceed immediately to laparotomy without further workup.For patients without an obviou

Abdominal TraumaMatthew D. Neal, L.D. Britt, Greg Watson, Alan Murdock and Andrew B. PeitzmanI.Abdominal injuries arc divided into two broad categorie

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2 be considered for patients with:a.Abnormal or equivocal abdominal evaluationb.Concurrent injury to the chest or pelvic ringc.Gross hematuriad.Diminis

hed level of consciousnesse.Spinal cord injuryf.Other injuries requiring a long general anesthetic for management, rendering repeat abdominal examinat Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

ion impossible.g.Diminished capacity to tolerate a delay in diagnosis of abdominal injury (e.g., extremes OỈ age)The diagnostic test used depends upon

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

the mechanism of injury, associated injuries, and hemodynamic stability. Remember that control of cavitary bleeding takes precedence over further dia

Abdominal TraumaMatthew D. Neal, L.D. Britt, Greg Watson, Alan Murdock and Andrew B. PeitzmanI.Abdominal injuries arc divided into two broad categorie

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2peritoneum. Plain abdominal films are rarely productive, but may show retroperitoneal gas or Hildings associated with abdominal injury' (e.g., fractur

es of rhe lumbar spine or lower rib cage).b.Laboratory evaluation. Patients with blunt injury received promptly from the scene may not be anemic or ac Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

idotic on presentation. Similarly, amylase levels can be normal with significant pancreatic or intestinal injury, or can be elevated from extra-abdomi

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

nal injury such as head and neck trauma.c.Focused assessment by sonography in trauma (FAST) is a rapid, noninvasivc means to identify hemoperitoneum i

Abdominal TraumaMatthew D. Neal, L.D. Britt, Greg Watson, Alan Murdock and Andrew B. PeitzmanI.Abdominal injuries arc divided into two broad categorie

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2thout obvious indication for laparotomy; any patient requiring prompt transfer to the OR for nonabdominal cause; or use as a screening rest for all ot

hers requiring abdominal evaluation.ii.Contraindications include obvious need for laparotomy or lack of FAST expertise.iii.Accuracy. Sensitivity and s Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

pecificity (60% to 85%) arc generally less than those of CT in detection of hemopcritoneum. It is not accurate for the detection and anatomic characte

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

rization of solid organ injury. FAST' is most valuable when positive in the hemodynamically unstable patient; prompt transfer to the operating room is

Abdominal TraumaMatthew D. Neal, L.D. Britt, Greg Watson, Alan Murdock and Andrew B. PeitzmanI.Abdominal injuries arc divided into two broad categorie

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2gnostic test (CT or DPL) in the patient incurring high-energy injury.iv.Advantages. Ultrasound is rapid and noninvasive; no need to transfer the patie

nt to the radiology suite; can be performed by a trained member of the trauma team; can be repeated; is less expensive than CT.V. Disadvantages. Can m Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

iss solid organ injury in the absence of hemoperitoneum or small amounts of hemoperitoneum; cannot distinguish between ascites, succus entericus and b

Ebook The trauma manual - trauma and acute care surgery (4/E): Part 2

lood; requires specialized training and competency; and is difficult to interpret in the obese or patients with extensive snlu'iiMnfniK etnnhvcfMna

Abdominal TraumaMatthew D. Neal, L.D. Britt, Greg Watson, Alan Murdock and Andrew B. PeitzmanI.Abdominal injuries arc divided into two broad categorie

Abdominal TraumaMatthew D. Neal, L.D. Britt, Greg Watson, Alan Murdock and Andrew B. PeitzmanI.Abdominal injuries arc divided into two broad categorie

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