May 31, 2017 the initial management of blunt abdominal trauma follows the principles of advanced trauma life support, including adherence to the abcs of trauma and balanced resuscitation. A high index of suspicion should be maintained for any multi trauma patient, particularly where the mechanism of injury may suggest significant abdominal injury. The signs and symptoms may include abdominal pain, tenderness, rigidity. Blunt and penetrating abdominal trauma are major causes of morbidity and mortality in the united states, particularly because it can be very difficult to recognize clear symptoms early. A free powerpoint ppt presentation displayed as a flash slide show on id. Blunt abdominal trauma in adults emergency management.
Intraabdominal injuries secondary to blunt force are attributed to collisions between the injured person and the external environment and to. Algorithm for management of blunt abdominal trauma. Management of blunt abdominal injury in children was restructured using an. Abdominal trauma is seen quite often in the emergency department and can result from blunt or penetrating mechanisms. Appreciate the necessity for emergent surgical intervention in certain abdominal trauma conditions. 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. Sep 14, 2019 abdominal trauma is classified as blunt or penetrating, assessment and management is modified accordingly. Evaluation of blunt abdominal trauma east 2002 nutritional support of the trauma patient east 2004. This guideline is intended for nonpregnant adult patients presenting to the emergency department with acute, blunt abdominal trauma.
Blunt abdominal injuries often managed conservatively, though interventional radiology and surgery are indicated for severe injuries. Statement of the problem evaluation of patients who have sustained blunt abdominal trauma bat may pose a significant diagnostic challenge to the most seasoned trauma surgeon. 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. An audit of management of cases of blunt trauma abdomen. This pediatric trauma extra cme supplement free to pediatric emergency medicine practice subscribers provides evidencebased recommendations for the evaluation and management of pediatric patients who present with blunt abdominal trauma. Abdominal trauma ppt major trauma medical specialties.
Most children with intra abdominal injuries can be managed nonoperatively. Blunt trauma produces a spectrum of injury from minor, singlesystem injury to devastating. Bladder rupture from blunt trauma is typically associated with pelvic fracture and results in gross hematuria. It is divided into two types blunt or penetrating and may involve damage to. The signs and symptoms may include abdominal pain, tenderness, rigidity and bruising of the external abdomen. 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. Blunt abdominal trauma 5758 blunt splenic trauma 5960. Blunt abdominal trauma is regularly encountered in the emergency department ed.
Acs tqip geriatric trauma management guidelines geriatric trauma rib frac ture management level 1 adult. Pdf management of renal injuries in blunt abdominal trauma. As there is a broad spectrum of abdominal injuries, abdom. Initial evaluation and management of blunt abdominal trauma in adults. Penetrating injuries include gunshot and shrapnel injuries, impalements, and knifings. Through better understanding of blunt abdominal trauma and advancements in diagnostics and non operative management techniques including. Abdominal trauma may involve penetrating or blunt injuries. Evaluation of abdominal trauma differential diagnosis of. Abdominal trauma is best categorized by mechanism as blunt or penetrating abdominal injury. Evaluation of patients who have sustained blunt abdominal trauma bat may pose a significant. 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. Common mechanisms include road traffic crashes, falls, sports injuries and assaults. Blunt abdominal trauma the royal melbourne hospital.
Therefore, the aim of this study was to describe the management strategies and outcomes of all pediatric patients with blunt intra abdominal injuries in our unique dedicated pediatric trauma center with a. Abdominal and pelvic trauma see initial evaluation and management of blunt abdominal trauma in adults and initial evaluation and management of abdominal stab wounds in adults and initial evaluation and management of abdominal gunshot wounds in adults and pelvic trauma. General informationpreamble evaluation of patients who have sustained blunt abdominal trauma. A hemodynamically unstable patient with a solid organ injury and intra abdominal hemorrhage or peritonitis is managed with emergent surgical exploration. Signs and symptoms include abdominal pain, tenderness, rigidity, and bruising of the external abdomen. Computed tomography is the gold standard for diagnosis of abdominal injuries in patients of trauma. Specific management depends on whether trauma is penetrating or blunt and on whether solid or hollow organs are injured. Primary trauma care primary trauma care manual standard edition 2000 a manual for trauma management. Perspectives on the management of abdominal trauma. In civilian practice approximately 20% of trauma injuries requiring surgery involve the abdomen 1. Abdominal trauma remains a leading cause of mortality in all age groups. Standardised process for the exclusion of injury of intra abdominal viscera in stable, blunt abdominal trauma patients, where conservative nonoperative management is considered appropriate.
The difference in severity between presenting symptoms and actual injuries in a significant number. Intra abdominal injury following blunt trauma becomes clinically apparent with 9 hours. Penetrating and blunt trauma to the abdomen can produce significant and lifethreatening injuries. Prospective comparison of diagnostic peritoneal lavage, computed tomographic scanning, and ultrasonography for the diagnosis of blunt abdominal trauma. Nonoperative management of these injuries has evolved over the past two decades3 only splenic injuries can be found in about one third of abdominal trauma and in 2530% of patients who suffered a traffic accident buccoliero and ruscelli, 2010. The lack of historical data and the presence of distracting. Contrastenhanced ultrasound ceus in blunt abdominal trauma. Management of renal injuries in blunt abdominal trauma article pdf available in journal of research in medical and dental science 22 april 2014 with 2,038 reads how we measure reads. Management of pediatric blunt abdominal trauma in a dutch.
Jan 02, 2019 treatment of blunt abdominal trauma begins at the scene of the injury and is continued upon the patients arrival at the emergency department ed or trauma center. Mortality and morbidity continue to be significant in blunt abdominal trauma. This guideline is intended for physicians working in hospitalbased emergency departments. Isolated abdominal injuries rarely 5% resulted in death, even though abdominal injuries accounted for 41% of.
Investigation of blunt abdominal trauma pubmed central pmc. The incidence and management of specific organ injuries with associated morbidity and mortality have been discussed. Evaluation and management of splenic injury in blunt. Ultrasonography in the management of blunt abdominal and thoracic trauma. With the active lifestyle of todays pregnant women, the effects of trauma have become an important obstetric concern. The initial management of blunt abdominal trauma follows the principles of advanced trauma life support, including adherence to the abcs of trauma and balanced resuscitation. 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 bat represents 75% of all blunt trauma and is the most common example of this injury. The mechanism of injury dictates the diagnostic workup. Fluid resuscitation is an important component of the management of abdominal injuries in children. Trauma is a physical injury caused by transfer of energy to and within the person involved. Compression forces are those that result in abdominal organs and blood vessels being crushed between solid objects.
Pediatric trauma guidelines page pediatric blunt spleenliver trauma management 1 pediatric blunt renal trauma management 23 pediatric extremity fracture 45 pediatric pelvic fracture 67 pediatric vte 89. Indications for laparotomy in a patient with blunt abdominal injury include the following. However, in europe, there are many different healthcare systems for the treatment of pediatric trauma patients. Trauma is the second largest cause of disease accounting for 16% of global burden. Abdominal trauma may be blunt or penetrating, but generally in civilian practice, blunt trauma is more common than penetrating and usually follows a road. The close proximity of organs within the torso makes distinguishing between abdomen, chest and pelvic injuries difficult.
Initial evaluation and management and minor pelvic fractures. Shearing forces cause tearing and rupture of solid organs and blood vessels at multiple sites. Evaluation of blunt abdominal trauma in the third trimester. Blunt trauma results in compression and shearing force injuries. 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. Abdominal trauma continues to account for a large number of trauma related injuries and deaths. Diagnosis and management of blunt abdominal trauma. Background information abdominal trauma in pregnancy may lead to. Blunt abdominal trauma, splenectomy, and postsplenectomy. Trauma meets the pandemic criteria, with a daily worldwide mortality as high as 16000. Use of dpl and ct decreased by 94% and 63%, respectively, in group 2.
General informationpreamble evaluation of patients who have sustained blunt abdominal trauma bat may pose significant. What if you suspect a coexistent pelvic fracture or traumatic brain injury. Abdominal trauma is classified as blunt or penetrating, assessment and management is modified accordingly. Defining the extent of injury after blunt abdominal trauma can be difficult even for an experienced. 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. Do you know when to go straight to the operating theatre, the ct scanner or to hold fast. Ct permits nonoperative management of select injuries. Penetrating injuries often result in injury to hollow organs, such as the intestines. Pdf challenges in management of blunt abdominal trauma. Blunt abdominal trauma potential hollow visceral injury. Complications may include blood loss and infection diagnosis may involve ultrasonography, computed tomography, and peritoneal lavage, and treatment may involve surgery. Practice management guidelines for the evaluation of blunt.
Treatment of blunt abdominal trauma begins at the scene of the injury and is continued upon the patients arrival at the emergency department ed or trauma center. Abdominal trauma accounts for 22% of body regions injured in major trauma and can be difficult to diagnose and manage 2. Mckenney kl 1997 cost reduction using ultrasound in blunt abdominal trauma. Nursing care and medical management from the initial evaluation through discharge are discussed. Practice management guidelines for the evaluation of blunt abdominal trauma. Ppt abdominal trauma powerpoint presentation free to. 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. Bai is common and usually results from motor vehicle collisions. Many serious abdominal injuries may appear insignificant, making it extremely difficult to predict severity. May 29, 2015 blunt abdominal trauma management next best step. Blunt abdominal trauma, evaluation of practice management. Haemoglobin levels should be interpreted according to time since injury, amount of fluid administration and extent of haemorrhage. Haematocrit below 30% increases the likelihood of intra abdominal injury in the setting of blunt abdominal trauma.
Pdf management of renal injuries in blunt abdominal. Associated injuries outside that cavity should be considered in all patients. Direct blow to flank, assoc intra abdominal injuries or a deceleration injury. Isolated abdominal injuries rarely 5% resulted in death, even though abdominal injuries accounted for. Perspectives on the management of abdominal trauma austin.
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. In australia blunt trauma accounts for 90% of admitted trauma cases, 22% of whom sustain a blunt abdominal trauma bat 1. Abdominal trauma is responsible for about 10% of all deaths related to trama. Blunt abdominal trauma bat is a frequent emergency and is associated with significant morbidity and mortality in spite of improved recognition, diagnosis and management. 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. Management of renal injuries in blunt abdominal trauma. Management may involve nonoperative measures or surgical treatment, as appropriate.
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