Fewer unnecessary radiological exams What are the disadvantages of FAST/US?.Can be performed in the primary or secondary survey without moving patients.Accurately assesses for and evaluates the extent of blood in the peritoneum.Timely diagnosis of blunt abdominal trauma.Diagnostic Peritoneal Lavage- largely has been replaced by FAST exam What are the modalities most commonly used to determine if a laparotomy is indicated in patients with blunt abdominal trauma? US (not very sensitive)ĬT (more accurate, but time-consuming and can miss perfs or ruptures)ĭPL (diagnostic peritoneal lavage)- fast but invasive may miss injuries in diaphragm or retroperitoneal structures is rarely used When do we use a US for diagnosis of abdominal injuries? -any patient that meets criteria for DPL or CT What are the benefits of FAST/US ?.Ultrasound has high specificity but low sensitivity for the detection of free fluid or visceral damage.CT scanning is preferred method but requires patient to be cardiovascularly stable.Either CT or ultrasound can be used for the assessment of abdominal trauma.Intra-peritoneal bladder injury What methods of imaging will we use for abdominal trauma?.Radiological evidence of intraperitoneal gas or ruptured diaphragm.Positive result on diagnostic peritoneal lavage.Peritoneal signs, rigid, silent abdomen or unexplained shock.Bowel sounds unreliable What is the most reliable indicator of intra-abdominal hemorrhage? Presence of shock without an identifiable source What are the indications for exploratory laparotomy?.Gastric aspirate and urine should be inspected for blood.Perineal and rectal examination for anal tone, prostatic position, blood or other evidence of injury.Rebound tenderness What is included on physical exam of abdominal trauma?.pattern of injury will be different between penetrating and blunt trauma What are the S+ sxs of abdominal trauma? - Pain As many as 20% of patients with acute hemoperitoneum will have a benign abdominal exam Even in alert patients abdominal tenderness is absent in 25-30% of with intra-abdominal injury Injury to adjacent structures (pelvis, chest) pedestrian What are some things that may make assessment of patients with abdominal trauma difficult? -Altered sensorium (head injury, alcohol) What are the mechanisms of blunt abdominal trauma? - Compression, shearing and deceleration forces (compression of abdominal contents against vertebral column or rib cage)
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