Abdominal Trauma
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 6 November 2016
⏱️ 9 minutes
🧾️ Download transcript
Summary
Step 1: Does This Patient Need Surgery NOW?
* Obvious penetrating injury to abdomen* Peritonitis* Hypotensive
Step 2: FAST Scan
* Performed with bedside ultrasound machine* Blood/intra-peritoneal fluid is hypoechoic (black) in appearance* Four views required* Right upper quadrant* Probe marker points towards patient’s head* “Morrisons Pouch”* Potential space between liver and right kidney* Left upper quadrant* Probe marker towards patient’s head* Most difficult view to obtain* Potential space around spleen and between spleen and left kidney* Suprapubic* Probe marker towards patient’s head* Looking for thin rim of fluid between bladder wall and bowel wall* Subxiphoid* Hold probe flat and aim through liver towards heart* Looking for fluid around heart and evidence of cardiac tamponade
Step 3: Consider the Mechanism
* Low risk* Low speed MVAs* Falling down only a few steps* High risk* Falling off ladder/roof* High velocity MVA/impact
Step 4: Perform Careful Abdominal Exam
* Pain* Bruising/Seatbelt sign* Distension* Peritonitis* Rigidity* Rebound* Guarding
Step 5: Obtain Imaging if High Risk Mechanism or Abnormal Exam
* CT Abdomen/Pelvis with IV contrast* If normal CT scan but you still have clinical concern- ADMIT* Serial abdominal exams* CT notorious for missing small bowel and diaphragmatic injuries
Additional Reading
* Trauma Basics (EM Clerkship)* FAST Examination (SAEM)
Transcript
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| 0:00.0 | Hello, med students. My name is Zach Olson and thank you for downloading this week's episode of the EM Clerkship podcast. |
| 0:10.6 | We are still on our trauma series. I know you're probably getting pretty burned out on all this trauma right now, but we're almost done. |
| 0:17.8 | If you stick with me, you're going to be all over these cases, not just as a student, |
| 0:23.7 | but as a resident too. So just hang with me. Here's this week's case. |
| 0:36.0 | University Hospital's Ambulance 48 in route to you with a trauma alert. |
| 0:39.3 | Got an 18-year-old male was a competitor at a bull riding competition, was thrown off, |
| 0:44.3 | landed on the top railing on the fence on his abdomen. |
| 0:47.3 | His complaining of 9 out of 10 pain and positive for rebound tenderness. |
| 0:51.3 | We are going to do an ultrasound in a minute here. I just wanted to |
| 0:55.1 | give you a quick call. We're still about 20 minutes out. Currently BP is 100 over 60 pulse of 140. Respirations |
| 1:03.2 | are at 28 right now. We do have them on 15 liters of 2 via non-re breather. We have two large |
| 1:08.6 | bore IVs started. Parents are also with us. We're going to do an ultrasound. We'll give you a call back and update you. |
| 1:18.9 | Now think closely about this EMS call. This is clear, obvious abdominal trauma. Easy. This patient's |
| 1:32.3 | probably going to need surgery. That's not the point of today's episode. What I want you to remember |
| 1:37.3 | today is mechanism exam imaging. Mechanism exam imaging. Because here's the deal. Unlike all of Exam. Imaging. |
| 1:45.9 | Mechanism exam imaging. |
| 1:47.3 | Because here's the deal. |
| 1:49.9 | Unlike all of these other injuries we've talked about, |
| 1:54.8 | abdominal injuries, specifically blunt abdominal injuries, |
| 1:57.0 | are never straightforward. |
| 2:03.6 | We don't have fancy decision rules that we can use to determine what to do. Even the CT scan, the gold standard imaging study for abdominal pain is nowhere close to 100%. |
| 2:10.6 | And everybody knows it. |
... |
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