General Surgery – Abdominal Injuries: By Stephanie Mason M.D. скачать в хорошем качестве

General Surgery – Abdominal Injuries: By Stephanie Mason M.D.

Abdominal injury is a medical emergency. Assessment of any patient who has sustained a trauma must follow the ATLS protocol. Abdominal injury refers to blunt or penetrating trauma to the abdomen determined by the mechanism of trauma. These types of injury lead to different types of organ dysfunction from hemorrhage to peritonitis, which can be deadly. Prompt recognition and management are necessary to prevent adverse outcomes. medskl.com is a global, free open access medical education (FOAMEd) project covering the fundamentals of clinical medicine with animations, lectures and concise summaries. medskl.com is working with over 170 award-winning medical school professors to provide content in 200+ clinical presentations for use in the classroom and for physician CME. General Surgery – Abdominal Injuries Whiteboard Animation Transcript with Stephanie Mason, MD https://medskl.com/module/index/abdom... Abdominal injuries occur commonly in both blunt and penetrating trauma, and can be life-threatening. The mechanism can give you a hint as to what injuries you might find. For example, the liver and spleen are commonly injured in blunt trauma, while penetrating injuries often involve the small bowel. In the trauma bay, I always follow ATLS protocol. The abdomen is one of the main sources of bleeding, so we begin with the primary survey. Look at the patient. Are they awake, comfortable and talking? Or do they look SICK? What are their vital signs – Are they in shock? Most patients should receive 1 liter of warmed fluid. Their response to this can be an extra clue to determine if, and how much, they are bleeding. Perform a FAST, a rapid bedside ultrasound looking for free fluid in the abdomen. If there’s fluid, it’s a positive FAST, and this fluid is usually blood. Then, as part of the secondary survey, do a full abdominal exam. Start with Inspection: Is there bleeding? Are there gun-shot or stab wounds? Is there a seatbelt sign that should make you very suspicious of organ injury? Then Palpation: is there any tenderness, or signs of peritonitis? This suggests perforation of the GI tract. Then, a DRE: is the prostate normal? Is there any rectal blood? A high riding prostate suggests urethral injury, as does blood at the meatus. If you see these, don’t put in a catheter! Now we can decide if this patient requires an emergency laparotomy. If the patient has: A positive FAST with hypotension and tachycardia Peritonitis Stab wounds that penetrate the abdominal fascia … then they need an operation NOW. Otherwise, we have time to do a CT scan to visualize and characterize any intra-abdominal injuries or active bleeding. The CT scan, combined with findings from our physical exam and FAST, helps us decide the next steps. This might be an operation, angiography, or observation.