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www.gitfreed.a.i. Hey guys, it's Mike Estefan from the University of Rochester School of Medicine.

Today, we're going to continue where we left off with part two of this first episode of the Emergency Medicine Shelf Exam Review series.

The focus of this episode is going to be trauma, beginning with penetrating abdominal trauma.

Let's say we have a guy who comes in and he's shot just below his right nipple.

What's the next step for this guy?

So this guy needs an exploratory laparotomy, also known as an X-lap.

Any gunshot wound to the belly that goes through the peritoneum gets an X-lap regardless of peritoneal signs or of the patient's

blood pressure. And fun fact, any injury below the fourth intercostal space, which is approximately

at the level of the nipple, has the potential to be abdominal in nature.

All right.

So let's say another guy comes in and he's got a stab wound to his belly.

What three signs are you looking for that would influence your decision on whether or not to get some diagnostic testing before sending this guy to the OR.

So for the exam, in general, there are three signs that would indicate that you do not have time to do some diagnostic testing in this guy with a stab wound to his belly.

The first sign would be hemodynamic instability, which is essentially hypotension after resuscitation attempts.

Your second sign is going to be the presence of any signs of paratinitis, such as rebound or guarding.

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