Ivan Zamorano

Acupunture Treatment

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

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


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.

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