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Blunt Abdominal Trauma

Case presentation
by

Peter Scaletty

on 17 December 2010

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Transcript of Blunt Abdominal Trauma

Blunt Abdominal Trauma High speed MVA with a restrained driver
Walking and conscious at the scene.
Severe constant pain: right leg, abdomen and neck. Pertinent negatives: no chest pain, no numbness, no visual change, no loss of consciousness, no tingling and no shortness of breath. HPI Exam AOx3, GCS 15, Skin is warm and dry, normal mood and affect, FAST Exam: positive for a small area of fluid on the right upper quadrant hepatic view Cardiovascular: Tachycardia and hypotensive Pulmonary/Chest: Breath sounds normal. Tachypnea noted. No chest tenderness. Abdominal: Soft. Tenderness is present. He has no rebound and no guarding. Pete Scaletty Trauma Cardiac
Tamponade Cardiac Shock Outcome The pt was transfused multiple times he remained unstable The pt coded, a left anterolateral thoracotomy was performed and evacuation of pericardial hematoma Internal cardiac massage and internal cardiac defibrillation were unable to resuscitate the patient. What will Kill the Pt Cardiac Tamponade
Cardiac rupture
Esophageal rupture
Tension pneumothorax
Pulmonary Embolism
Aortic Disection Evaluation Vitals Labs Vitals signs are vital History
Rib Fracture Mechanism
Blunt v. Penetrating ABCDE Primary survey GCS, pupil size, and reactivity and motor function Secondary survey Head-to-Toe exam for injury cervical spine stabalization
Gag reflex, pooling, obstruction, deviation
Breath sounds Airway & Breathing Circulation Stable Unstalbe Beck's Triad Hypotension
JVD
muffled heart sounds References
Abdominal Trauma: The Black Box, Richard E. Wolfe, MD, FADEP: Boston Sientific Assembly Oct. 5 2009 Emergency Mecine just the facts, O. John Ma and David M. Cline: The McGraw Hill companies, 2004 Cardiac Tamponade, Brian D. Hoit, MD: Uptodate.com Sep. 30 2010 Diagnonsis Clinical Pericardial sac pressure > heart chamber pressure Other findings Sinus tachycardia
Pulsus paradoxus
Kussmaul's sign
Pericardial rub Treatment
Pericardiocentesis v. Thoracotomy Etiology: Malignancy, PCI, MI (68%) Trauma (3%) Bloody pericardial effusion in pt with cardiac tamponade: is the cause of canerous tubercolous or iatrogenic in the 1990's, Atar S, Chiu J, Forrester JS, Siegel RJ: Chest. 1999; 116(6): 1564-9. Etiology: Trauma 1-3: Mediastenial injury
9-12: Intra-abdominal injury Flail chest
3+ ajacent ribs
fx in 2 spots
peridoxial movement Managment NSAIDS, Opioids, and/or nerve block
Plus incentive spirometery
Restrict activity 4-6 weeks Rib fracture, Kristine A Karlson
Uptodate.com, Sept. 29 2010 Clinical maifestations and diagnosis of cardiogenic shock, Judith S Hochman, MD; Venu Menon, MD: Uptodate.com Sept 2010 persistent hypotension with severe decreased
cardiac index and adequate filling pressure Diagnosis Echocardiography
Hemodynamic monitoring (PCWP, A-Line...)
Cardiac catheterization Treatment Treat underlying cause
Pressers (Dopamin is first line) Etiology: Pump failure, Mechanical complication, Other
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