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Types and causes of abdominal trauma
- Causes
- Blunt Trauma
- MVA
- Falls
- Compression injuries
- Shearing injuries
- Penetrating Trauma
- Gun Shot wound
- Stabbing
- Types of Injuries
- Lacerated liver
- Ruptured spleen, bladder, diaphragm, stomach or intestine
- Renal or pancreas injury
- Mesenteric artery tears
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Cinical manifestations of abdominal trauma
- Abdominal pain
- Pain over scapula: (phrenic nerve irritation by blood)
- Guarding/splinting (peritonitis)
- Hard, distended abdomen (bleeding)
- Decreased or absent bowel sounds
- Contusions, abrasions, bruising
- (seat belt injury)
- Hematemesis or hematuria
- s/sx hypovolemic shock
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What are cullen's and grey turner's signs?
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Diagnostics studies involved with abd trauma
- Labs:
- --CBC
- --Urinalysis
- --ABG
- --PT
- --Lytes
- --BUN
- Abdominal Ultrasound
- CT of Abdomen
- Diagnostic Peritoneal Lavage
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Collaborative management of pt w/abd trauma
- Emergency Management
- Patent Airway
- Breathing
- Fluid replacement
- Prevention of Hypovolemic Shock
- IV line- Large bore, preferrably two to give blood, volume expanders
- NG tube
- Emergency Laparatomy
- Impaled object should only be removed with skilled care available
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What is peritonitis?
- What? Localized or generalized inflammation of peritoneum.
- --Primary: blood-borne organisms enter the peritoneal cavity (cirrhosis)
- --Secondary: abdominal organs perforate or rupture and release contents (bile, enzymes, bacteria) into peritoneal cavity
- Why? Ruptured appendix, perforated gastric or duodenal ulcer, severely inflamed gall bladder, trauma
- Symptoms? Rebound tenderness, guarding of abdomen, “board like abdomen”, restlessness, shallow respirations, abdominal distention, fever/chills, tachycardia, tachypnea, nausea, vomiting, pallor
- Complications: Hypovolemia!
- Can be Fatal! Don’t delay treatment
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Diagnostics for peritonitis
- CBC
- Peritoneal Aspiration: (blood, pus, bacteria, fungus, amylase)
- Abdominal X-ray: (free air-perforation, air and fluid-obstruction)
- CT or Ultrasound: (ascites, abscesses)
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Management of pt w/peritonitis
- Surgery
- Antibiotics
- NPO
- NG suction
- Analgesics
- IV Fluids
- Oxygen
- Parenteral Nutrition
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