It would be hypothesized that experienced trauma surgeons initial clinical evaluation is accurate for excluding lifethreatening blunt injuries. The spleen and the liver are the organs that are more severely affected in blunt trauma. Penetrating chest injuries below the 5th intercostal space may traverse. The most common blunt trauma injuries occur in the spleen and the liver. Blunt abdominal trauma bat accounts for the majority 80 percent of abdominal injuries seen in the emergency department, and is responsible for substantial morbidity and mortality. The double jeopardy of blunt thoracoabdominal trauma trauma. Approximately 75% of blunt trauma injuries are a result of motor vehicle accidents 8. The difference in severity between presenting symptoms and actual injuries in a significant number. Gastrointestinal perforation following blunt abdominal trauma. The initial steps depend on the haemodynamic stability of the patient. Abdominal trauma is classified as blunt or penetrating, assessment and management is modified accordingly. Algorithm for management of blunt abdominal trauma. The abdomen can be injured in many types of trauma.
Pediatric blunt abdominal trauma emergency medicine. Patients were divided into three groups including low score computed tomography has an important role in hollow viscus and mesenteric injuries after blunt abdominal trauma. Because the risk of iai varies greatly with each given mechanism of trauma in the preverbal age group, the provider should err on. 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. Blunt abdominal trauma the royal melbourne hospital. The investigation of blunt abdominal trauma is a challenging and contentious subject with a limited evidence base. The management of blunt abdominal injury bai has undergone quite significant changes over recent years. If untreated, high pressures are sustained and the illness progresses to abdominal compartment syndrome acs.
The workgroup meets regularly to encourage communication among services, and to. Marwan a, harmon cm, georgeson ke, smith gf, muensterer oj. The majority of bat cases 75 percent are related to motor vehicle collision mvc or auto versus pedestrian accidents 2. The patterns of chest injury are highly dependent on the intensity of the trauma and. The accurate and timely diagnosis of blunt intraabdominal injury iai is a common dilemma. Evaluation of abdominal trauma american college of surgeons. Abdominal trauma is responsible for about 10% of all deaths related to trama.
In tropical africa, it is only beginning to assume importance as infections and malnutrition are controlled. Blunt abdominal injury aftercare instructions what you. Blunt trauma is most commonly due to motor vehicle accidents and is a major cause of morbidity and mortality in all age groups. Imaging of blunt abdominal trauma university of ottawa. Findings of abdominal trauma haemoperitoneum splenic trauma. Oct 17, 2019 marwan a, harmon cm, georgeson ke, smith gf, muensterer oj. In developed countries, the availability of advanced imaging modalities has now reduced the necessity for laparotomy to less than 10% following blunt abdominal trauma bat in children. It is used aggressively for nonoperative control of hemorrhage, thereby obviating. Abdominal trauma may involve penetrating or blunt injuries. Apr 26, 2008 the investigation of blunt abdominal trauma is a challenging and contentious subject with a limited evidence base. In blunt abdominal trauma, including severe solid organ injuries, selective nonoperative management has become the standard of care.
Blunt trauma is defined as the single or repeated impact of an object without sharp edges or sharpened surfaces on the body. Abdominal trauma ppt major trauma medical specialties. 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. Blunt abdominal trauma is present in 10% of the patients who are admitted to emergency centers 7. Em005 blunt abdominal trauma assessment life threatening consequences of blunt abdominal trauma 1. Penetrating abdominal trauma is usually diagnosed based on clinical signs, blunt abdominal trauma is more likely to be missed because clinical signs are less obvious.
A blunt abdominal injury is a direct blow to the abdomen without an open wound. The nature and severity of abdominal injuries vary widely depending on the mechanism and forces involved, thus generalizations about mortality and need for operative repair tend to be misleading. The patterns of chest injury are highly dependent on the intensity of the trauma and may vary. Blunt abdominal trauma bat represents 75% of all blunt trauma and is the most common example of this injury. Upon the completion of this cme article, the reader will be able to. Use of laparoscopy in the management of pediatric abdominal trauma. Prediction of blunt traumatic injuries and hospital admission. An update of the 2004 policy on the evaluation of adult emergency department patients with acute blunt abdominal trauma. Evaluation and management of abdominal stab wounds. Asymptomatic flankposterior stab or gunshot wound 6. Gastrointestinal perforation following blunt abdominal trauma article pdf available in east african medical journal 849. 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.
Penetrating injuries include gunshot and shrapnel injuries, impalements, and knifings. It addresses issues around diagnosis using ultrasound and. These injuries are caused by car accidents, sports injuries, or a fall. The accuracy of physical examination has been questioned by multiple previous studies, 1,2 while others have suggested that the optimal method of diagnosis is via serial examination by an experienced trauma surgeon.
Aug 31, 2016 we evaluated the ability of experienced trauma surgeons to accurately predict specific blunt injuries, as well as patient disposition from the emergency department ed, based only on the initial clinical evaluation and prior to any imaging studies. The signs and symptoms may include abdominal pain, tenderness, rigidity. The spleen is the organ damaged most commonly, followed by the liver and a hollow viscus typically the small intesti. 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. This figure is consistent with the 515% reported in other series, making the intestine the third most commonly injured organ in blunt trauma. Seat belts reduce the incidence of injuries such as head injury and chest injury, but present a threat to such abdominal organs as the pancreas and the intestines, which may be displaced or compressed against the spinal column. In the setting of blunt abdominal trauma, the reported rate of occurrence of bowel and mesenteric injuries ranges from 1% to 5%. Blunt abdominal trauma is regularly encountered in the emergency department ed. Blunt abdominal trauma most patients with multiple trauma and distracting injuries andor altered sensorium should have testing of the abdomen as should patients with findings on examination. Other digestive system diagnoses with cc abdominal trauma accounts for approximately 15% of all traumarelated deaths. Intra abdominal bleeding vascular injury or solid organ rupture 2. 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. Abdominal trauma is divided into blunt and penetrating types. Angiography is a valuable modality in nonoperative management of abdominal solid organ injuries from blunt trauma in adults.
Impact force is defined by the amount of energy involved e. Traumatic lacerations to the right and left liver lobes arrows, image 1a and pancreas image 1b, arrow with left renal pedicle injury lack of enhancement of the left kidney. Penetrating injuries often result in injury to hollow organs, such as the intestines. Penetrating and blunt trauma to the abdomen can produce significant and lifethreatening injuries. The lack of historical data and the presence of distracting injuries or altered mental status, from head injury or intoxication, can make these injuries difficult to diagnose and manage. Organs such as your pancreas, liver, spleen, or bladder may be injured. The latter is often referred to as blunt force trauma, though it can also result from highvelocity impact. Most of these injuries are due to motor vehicle collisions 74%, and the incorrect placement of safety belts has been implicated as an additional risk factor. Among the main causes of death by trauma is bleeding due to abdominal organ injuries.
Blunt trauma is physical trauma to a body part, either by impact, injury or physical attack. 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. 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. Abdominal trauma is usually divided into blunt and penetrating trauma. Blunt trauma knowledge for medical students and physicians.
Abdominal and pelvic trauma is generally divided into blunt. The diaphragm changes its position during the respiratory cycle. Motor vehicle collisions are a common source of blunt abdominal trauma. An accurate scoring system for intra abdominal injury iai based on clinical manifestation and examination may decrease unnecessary ct scans, save time, and reduce healthcare cost. The validity of abdominal examination in blunt trauma patients with distracting injuries. Abdominal trauma definition of abdominal trauma by. 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. 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. This pathway provides guidance for imaging adult patients with blunt abdominal trauma.
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. Citescore values are based on citation counts in a given year e. Although patients with a prolonged altered mental status caused by brain or other associated injuries are less common in penetrating versus blunt trauma, there. Many serious abdominal injuries may appear insignificant, making it extremely difficult to predict severity. Blunt abdominal trauma free download as powerpoint presentation. The close proximity of organs within the torso makes distinguishing between abdomen, chest and pelvic injuries difficult. Blunt smallbowel injury occurs infrequently, with an incidence of 1. The validity of abdominal examination in blunt trauma. In australia blunt trauma accounts for 90% of admitted trauma cases, 22% of whom sustain a blunt abdominal trauma bat 1. Early recognition of such injuries significantly decreases morbidity and. Forensic traumatology blunt and penetrating trauma. Algorithm for management of blunt abdominal trauma authorstream. Perspectives on the management of abdominal trauma journal of.
Abdominal trauma may be blunt or penetrating, but generally in civilian practice, blunt trauma is more common than penetrating and usually. We distinguish between direct trauma when the injury occurs in the same location of the trauma, and indirect trauma, when there are 2 different locations. Regardless of restraint usage, associated injuries are. 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. Blunt trauma leads to injury when the elastic limit or breaking point of an organ is exceeded by the impact force applied. Feb 03, 2020 a blunt abdominal injury is a direct blow to the abdomen without an open wound. 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. The most common signs of significant abdominal trauma are pain, gastrointestinal hemorrhage, hypovolemia, and peritoneal irritation.
Intraabdominal injury following blunt trauma becomes. This study is designed to provide a new scoring system for a better. Victims of blunt trauma often have both abdominal and extraabdominal. Stomach, esophageal, and duodenal procedure with major cc drg category. Typically, clinicians use ultrasonography or ct, or sometimes both. Trauma is the leading cause of death in children in developed countries. Patients and methods during the 12month period from december 1, 2012, to. Blunt trauma may involve a direct blow eg, kick, impact with an object eg, fall on bicycle handlebars, or sudden deceleration eg, fall from a height, vehicle crash. Blunt abdominal injuries often managed conservatively, though. The algorithm proposed here is widely accepted and should help doctors in emergency departments decide on the most appropriate form of investigation pending the arrival of a specialist. The accurate and timely diagnosis of blunt intra abdominal injury iai is a common dilemma. The spleen is the organ damaged most commonly, followed by the liver and a hollow viscus typically the small intestine. Bedside emergency ultrasonographic diagnosis of diaphragmatic rupture in blunt abdominal trauma. Assessment of abdominal trauma requires the identification of immediately lifethreatening injuries on primary survey, and delayed life threats on secondary survey.
Diaphragmatic rupture early surgical referral blunt injury to the abdomen and abdomen with any of the following. Abdominal infection is a generally accepted contraindication for donation of abdominal organs. Evaluation of patients who have sustained blunt abdominal trauma bat may. Gastrointestinal injuries from blunt abdominal trauma in children. Describe the different types of ct imaging techniques and the usefulness of contrast agents when evaluating a patient with blunt abdominal trauma. Children are especially vulnerable to abdominal injury from seat.
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