The diagnosis of blunt abdominal trauma can be challenging and resource intensive. Occult bowel injury after blunt abdominal trauma the american. Evaluation of patients who have sustained blunt abdominal trauma bat may. The pressure within the abdominal cavity, or intra abdominal pressure in a normal person is 05 mmhg.
Abdominal trauma cdr john p wei, usn mc md 4th medical battalion, 4th mlg bsrf12 abdominal trauma blunt abdominal trauma solid organ injuries including liver, spleen, kidneys, pancreas rupture of hollow viscus including small and large intestine, stomach, esophagus, and bladder vascular injuries bony fractures of pelvis and lumbar spine penetrating abdominal trauma. In australia blunt trauma accounts for 90% of admitted trauma cases, 22% of whom sustain a blunt abdominal trauma bat 1. The difference in severity between presenting symptoms and actual injuries in a significant number. Evaluation for blunt abdominal trauma disclaimer the documents and related information presented here have been submitted to the american association for the surgery of trauma the aast by other parties and are made available by the aast only for general informational purposes. Common abdominal organ injuries involve the liver, spleen, kidneys, intestines and vasculature. The abdomen can be injured in many types of trauma.
Algorithm for management of blunt abdominal trauma. Penetrating abdominal trauma trinity college dublin. Get a printable copy pdf file of the complete article 1. Motor vehicle accidents are the leading cause of blunt abdominal trauma with the liver and spleen being most commonly injured. Stony brook university medical center stony brook, ny. Abdominal trauma represents an important part of daycare activity in radiology. Intraabdominal injury following blunt trauma becomes. In the setting of blunt abdominal trauma, the reported rate of occurrence of bowel and mesenteric injuries ranges from 1% to 5%. Identifying children at very low risk of clinically. Abdominal trauma may involve penetrating or blunt injuries. Although this age group is included in studies that addressed pediatric blunt abdominal trauma, preverbal children are underrepresented and not specifically substratified. Penetrating abdominal trauma 25 penetrating abdominal trauma jarrod wall, 6th year medicine introduction penetrating abdominal trauma is not uncommon and is usually associated with stab wounds, impalement and less commonly bullet wounds or explosions. The most common mechanism of blunt abdominal trauma is a car crash. Blunt abdominal trauma is the commonest cause of intra abdominal injuries in children.
Blunt abdominal trauma bat represents 75% of all blunt trauma and is the most common example of this injury. Focused assessment with sonography for trauma examination has replaced. Blunt abdominal trauma is more common in men than women. Intra abdominal free fluid without solid organ injury in blunt abdominal trauma. George hospital trauma committee approved by sgh trauma committee on 24042007 i. A retrospective analysis based on existing, diagnostic ct scan reports taken during a 5 year period from 245 consecutive patients with blunt abdominal trauma. Following blunt abdominal trauma, bowel injuries are often missed on admission computed tomography ct scan. Chapter 10 does ct scan for blunt abdominal trauma in children amount to a lot of radiation for little yield. While penetrating abdominal trauma pat is usually diagnosed based on clinical signs, diagnosis of blunt abdominal trauma is more likely to be delayed or altogether missed because clinical signs are less obvious. When evaluating a patient for abdominal trauma, it is necessary to think of the abdomen as three separate areas, which consist of the peritoneal cavity, pelvis, and the retro peritoneum. Intestinal perforation is an important diagnostic challenge following blunt abdominal trauma. Equivocal abdominal exam ongoing blood loss hematuria prolonged operation for other injuries immediate operation peritonitis on exam hypotension with.
Cheryl pirozzi, md fellows conference 5411 abdominal trauma penetrating abdominal trauma stabbing 3x more common than firearm wounds gsw cause 90% of the deaths most commonly injured organs. Intraabdominal free fluid without solid organ injury in blunt abdominal trauma. Patients with solid organ injury or intraabdominal injury can be. Trauma clinical guideline evaluation and management of blunt abdominal trauma the trauma medical directors and program managers workgroup is an open forum for designated trauma services in washington state to share ideas and concerns about providing trauma care. Intraabdominal bleeding vascular injury or solid organ rupture 2. Intra abdominal bleeding vascular injury or solid organ rupture 2.
There are a wide variety of complex structures in each of these areas each with their own unique problems when injured. The role of computed tomography in blunt abdominal trauma. Abdominal trauma remains a leading cause of mortality in all age groups. A protocol was developed to monitor pregnancies complicated by major blunt abdominal trauma in the third trimester, looking specifically for delayed placental andor fetal problems. Introduction abdominal trauma is regularly encountered in the emergency department one of the leading cause of death and disability identification of serious intraabdominal injuries is often challenging many injuries may not manifest during the initial assessment and treatment period. Blunt trauma knowledge for medical students and physicians. The workgroup meets regularly to encourage communication among services, and to. Bai is common and usually results from motor vehicle collisions. Various factors, including blunt trauma can lead to increased abdominal pressure or intra abdominal hypertension which is defined as sustained pressures over 12 mmhg lee, 2012. Dpl or ultrasound evisceration open pelvic fracture anterior stab wound 4 gunshot wound ultrasound or ct ultrasound or dpl 2. Abdominal trauma cdr john p wei, usn mc md 4th medical battalion, 4th mlg bsrf12 abdominal trauma blunt abdominal trauma solid organ injuries including liver, spleen, kidneys, pancreas rupture of hollow viscus including small and large intestine, stomach, esophagus, and bladder vascular injuries bony fractures of pelvis and lumbar spine penetrating abdominal trauma mechanism of wounding and.
Jan 23, 2011 table diagnostic modalities in abdominal trauma peritoneal lavage ultrasound ct scan use records intra abdominal haemorrhage in stableunstable trauma reveals intra abdominal haemorrhage in stable and unstable in patients reveals organ of injury and extent of blunt penetrating abdominal trauma in stable patients contraindications urgent demand. Abdominal trauma is a topic covered in the diseases and disorders to view the entire topic, please sign in or purchase a subscription nursing central is an awardwinning, complete mobile solution for. Mann, md i solated blunt abdominal trauma bat represents about. Falling from height, direct hit to the abdomen, fight, football, and crushing are other causes of blunt abdominal trauma. Abdominal trauma ppt major trauma medical specialties. The finding of more than trace amounts of free fluid in the absence of solid organ injury in bat is often associated with clinically significant visceral. Abdominal injuries are found in 2030% of patients with multiorgan injuries. Diagnosis and management of blunt abdominal trauma. Various factors, including blunt trauma can lead to increased abdominal pressure or intraabdominal hypertension which is defined as sustained pressures over 12 mmhg lee, 2012.
Changing patterns in diagnostic and treatment strategies in blunt. The pressure within the abdominal cavity, or intraabdominal pressure in a normal person is 05 mmhg. There was an 80% increase in the incidence of blunt abdominal trauma when compared with the preceding. Multidetector row ct imaging of blunt abdominal trauma.
Abdominal trauma is a topic covered in the diseases and disorders to view the entire topic, please sign in or purchase a subscription nursing central is an awardwinning, complete mobile solution for nurses and students. Abdominal trauma is divided into blunt and penetrating types. Observation with serial clinical assessments plays a major role in the evaluation of these patients, but the time required for intra abdominal injury to become clinically apparent is unknown. Blunt abdominal traumatic injuries can result from a number. Overview of abdominal trauma msd manual professional edition.
Intraabdominal injuries secondary to blunt force are attributed to collisions between the injured person and the external environment and to. Abdominal trauma is responsible for about 10% of all deaths related to trama. Blunt trauma is most commonly due to motor vehicle accidents and is a major cause of morbidity and mortality in all age groups. Findings of abdominal trauma haemoperitoneum splenic trauma. Blunt abdominal trauma the royal melbourne hospital. Abdominal trauma, especially those caused by blunt force is a leading cause of morbidity and mortality in all age groups, but it is one of the most challenging conditions emergency department physicians encounter because of varied presentations.
Algorithm for management of blunt abdominal trauma authorstream. Imaging of blunt abdominal trauma university of ottawa. The majority occurs in motor vehicle accidents, in which rapid deceleration may propel the driver into the steering wheel, dashboard, or seatbelt causing contusions in less serious cases, or rupture of internal organs from briefly increased intraluminal pressure in the more serious. At the royal melbourne hospital in 2016, bat accounted for 15% of all major trauma cases, of these 30% required a laparotomy and 18% required angioembolisation 2. The provider must consider the mechanism of trauma in assessing risk of injury. The most common signs of significant abdominal trauma are pain, gastrointestinal hemorrhage, hypovolemia, and peritoneal irritation. Blunt mechanism of injury penetrating evaluation by surgeon observation 1 normal exam asymptomatic flankposterior stab or gunshot wound 6 further diagnostic tests highrisk mechanism altered mental status equivocal abdominal exam ongoing blood loss hematuria prolonged operation for other injuries immediate operation. Pdf on jan 1, 2009, ricardo ferrada and others published blunt abdominal trauma find, read and cite all the research you need on researchgate. Diagnostic efficiency and importance of experience in using multidetector computed tomography original article ulus travma acil cerrahi derg, november 2014, vol. Nonsurgical treatment has become the standard of care in hemodynamically stable patients with abdominal trauma as a result of exhaustive and rigorous assessment of injury lesions by imaging. Abdominal trauma is usually divided into blunt and penetrating trauma. The management of blunt abdominal injury bai has undergone quite significant changes over recent years.
This guideline is intended for physicians working in hospitalbased emergency departments. Your healthcare provider will watch you closely to see if your injury is mild and your condition is stable. The management of blunt abdominal injury has changed considerably. Delayed jejunal perforation following blunt abdominal trauma. Common causes of abdominal injury include blunt trauma motor vehicle accidents mvas and falls, and penetrating trauma gunshot wounds gsws and stabbings. The nature and severity of abdominal injuries vary widely depending on the mechanism and forces involved, thus generalizations about mortality and need for. Penetrating injuries include gunshot and shrapnel injuries, impalements, and knifings.
Jan 02, 2019 blunt abdominal trauma see the image below is a leading cause of morbidity and mortality among all age groups. Introduction abdominal trauma is regularly encountered in the emergency department one of the leading cause of death and disability identification of serious intra abdominal injuries is often challenging many injuries may not manifest during the initial assessment and treatment period. With the active lifestyle of todays pregnant women, the effects of trauma have become an important obstetric concern. Mild injuries, such as bruising and soreness, will be monitored for a short time.
Blunt abdominal trauma see the image below is a leading cause of morbidity and mortality among all age groups. Em005 blunt abdominal trauma assessment life threatening consequences of blunt abdominal trauma 1. Identification of serious intra abdominal pathology is often challenging. A blunt abdominal injury is treated depending on how severe your injury is. Mar 15, 2012 evaluation for blunt abdominal trauma disclaimer the documents and related information presented here have been submitted to the american association for the surgery of trauma the aast by other parties and are made available by the aast only for general informational purposes. Blunt abdominal trauma journal major trauma causes of death. Blunt abdominal trauma is regularly encountered in the emergency department ed. Observation with serial clinical assessments plays a major role in the evaluation of these patients, but the time required for intraabdominal injury to become clinically apparent is unknown. This guideline is intended for nonpregnant adult patients presenting to the emergency department with acute, blunt abdominal trauma. Table diagnostic modalities in abdominal trauma peritoneal lavage ultrasound ct scan use records intraabdominal haemorrhage in stableunstable trauma reveals intraabdominal haemorrhage in stable and unstable in patients reveals organ of injury and extent of bluntpenetrating abdominal trauma in stable patients contraindications urgent demand. Feb 03, 2020 how is a blunt abdominal injury treated. Diaphragmatic rupture early surgical referral blunt injury to the abdomen and abdomen with any of the following.
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