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Abdominal trauma

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Abdominal trauma Traumatic disruption of normal anatomical and physiological configuration of abdominal wall with or without its content Outline Types of abdominal ... – PowerPoint PPT presentation

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Title: Abdominal trauma


1
Abdominal trauma
  • Traumatic disruption of normal anatomical and
    physiological configuration of abdominal wall
    with or without its content

2
Outline
  • Types of abdominal injuries
  • Primary survey and resuscitation
  • Diagnosis, screening and determination of injury
    severity (secondary survey)
  • Damage control
  • Definitive management
  • Abdominal compartment syndrome
  • Nutritional support
  • Organ preservation

3
Types of abdominal injuries
  • Blunt
  • Adult
  • VMA, fall, assault
  • Children
  • VMA, fall, child abuse
  • Penetrating
  • Broken bottles, knife, impaled stick
  • Perforating
  • Involvement of bowel lumen

4
Primary survey
  • Life and limb threatening injuries
  • Airway obstruction
  • Tension pneumothorax
  • Open pneumothorax
  • Cardiac tamponade
  • Massive pneumothorax
  • Flail chest
  • Gustillo injuries

5
Diagnosis
  • Clinical evaluation (secondary survey)
  • History
  • Mechanism of injury
  • Anatomy of injury
  • Physiology of injury
  • Premorbid status
  • Treatment received and complication
  • Examination
  • General
  • Systemic/regional
  • Monitoring

6
Screening examinations/tests
  • Abdominal paracentensis
  • Diagnostic peritoneal lavage
  • Computer tomography
  • Thoracoscopy
  • Focused assessment by sonography for trauma and
    other imaging techniques
  • Laboratory investigations

7
Determination of injury severity(The scoring
systems)
  • Physiologic
  • Glasgow coma scale
  • Champion score
  • Revised trauma score
  • Pediatric trauma score
  • Anatomic
  • Abbreviated injury score
  • Injury severity score
  • Penetrating abdominal trauma index
  • Anatomic profile
  • Combined

8
Damage control
  • Definition
  • Coordinated medical and surgical primary
    resuscitative measures in achieving a steady
    state in acutely injured patient before the
    definitive treatment.
  • Indications
  • Major abdominal vascular injuries with multiple
    visceral injury
  • Multiregional exsanquinating injuries with
    concomitant visceral injury
  • Multiregional injuries with competing priority
  • Severe metabolic acidosis pH gt7.3
  • Hypothermia T lt 35o C
  • Coagulopathy

9
Phases of damage control
  • Phase I
  • Control of hemorrhage
  • Hemostasis
  • Avoid complex repair
  • Control of contamination
  • Ligation
  • Drainage
  • Packing
  • Abdominal closure

10
Damage control
  • Phase II
  • maximization of hemodynamics
  • Core warming
  • Lavage
  • Increase ambient temprature
  • Infusion of warm fluid
  • External warming
  • Coagulopathy correction
  • Ventilatory support
  • Continuous monitoring for missed injury
  • Monitor for abdominal compartment syndrome
  • Phase III
  • Definitive treatment

11
Abdominal compartment syndrome
  • Definition
  • A clinical condition characterized by
    intraabdominal hypertension that leads to
    cardiorespiratory compromise and end organ
    hypoperfusion with resultant MODS and possible
    death.
  • Types
  • Primary commonly follows laparotomy for trauma
  • Secondary- follows massive resuscitation in
    patients with burns or extremities injury
  • Presentation
  • Abdominal distension (stony hard) with oliguria

12
Abdominal compartment syndrome
  • Classification
  • Class I pressure lt15mmHg
  • Class II pressure 16 25mmHg
  • Class III pressure 26 35mmHg
  • Class IV pressure gt 36mmHg
  • Diagnosis
  • Urinary bladder pressure measurement
  • Water column manometer
  • Intraarterial pressure transduser

13
Nutritional support
  • Indication
  • Patient with GCS lt 8
  • Extimated NPO gt 7 days
  • Prolonged ileus
  • High output enterocutaneous fistula
  • Mode
  • Enteral
  • Nasogastric
  • Nasoduodenal
  • Jejunostomy
  • Parenteral

14
Challenges
  • Trauma team
  • Trauma care station and facilities
  • FAST
  • Radiological facilities
  • Patients transportation
  • Theatre
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