The modified procedure of diagnostic peritoneal aspirate (DPA) is useful in the hemodynamically unstable abdominal trauma with a negative FAST scan - a positive DPA indicates a false negative FAST scan and such patients require emergency laparotomy.Modified technique required if pregnant, pelvic fracture or midline scarring.Residual fluid following DPL makes subsequent FAST scans unreliable.Rarely performed, practitioner’s have become deskilled.False positives may result from trauma during the procedure (up to 25% negative laparotomy rate).Highly sensitive for intraperitoneal hemorrhage (>97%).if negative: 1L of warm saline in -> effluent sent for RBC, WCC, food, bile, bacteria.mini-laparotomy with placement of lavage catheter (chest drain or Foley) into peritoneal cavity directed towards pelvis.It’s main role is when FAST and CT are unavailable or in mass casualty situations. DPL is now rarely performed due to the advent of the FAST scan.Can be technically difficult in obese patients, those with lots of bowel gas or if subcutaneous emphysema is present.Doesn’t look at solid organs, hollow viscus or retroperitoneal structures.ascites, residual fluid after DPL, bladder rupture) Does not distinguish other causes of intraperitioneal fluid (e.g.Doesn’t specify anatomical structures injured.Requires >250 mL free fluid to collect in Morison’s pouch for a positive result.Sensitivity approaching 96% in detecting >800mls blood.Patient doesn’t have to leave Emergency department.Quick to perform with immediate results.subxipoid: pericardial space + rough assessment of contractility and filling.In the absence of physical signs that indicate a need for immediate emergency laparotomy, imaging can be used to determine if emergency laparotomy is indicated, and help prioritise, identify and guide the management of other injuries Imaging (bedside FAST scan, +/- Ct abdomen if haemodynamically stable and imaging warranted).FBC, UEC, LFTs, lipase, coags, group and hold, BHCG) peritonism: ruptured viscus with leakage.crepitation of lower rib cage: hepatic or splenic injury. retroperitoneal haemorrhage: ecchymosis of the peri-umbilical area (Cullen’s sign) and the flanks (Grey-Turner’s sign).lap belt: 30% chance of mesenteric or intestinal injury.Secondary survey (search for signs that indicate need for emergency laparotomy) activation of massive transfusion protocol if needed.Initial examination of the abdomen is best performed in the ‘C’ phase of the primary survey, with the mindset of ‘Find the bleeding, stop the bleeding’.Abdominal and pelvic injuries may cause life-threatening hemorrhage.Use a coordinated team-based systematic approach aimed at identifying, prioritising and treating immediate and delayed life-threats.Between the posterior axillary lines extending from the costal margin to the iliac crests. From the inferior costal margin superiorly to the iliac crests bound anteriorly by the anterior axillary line and posteriorly by the posterior axillary line. Injuries in the region increase the likelihood of chest, mediastinal, and diaphragmatic injuries. - The area superiorly delimited by the fourth intercostal space (anterior), sixth intercostal space (lateral), and eighth intercostal space (posterior), and inferiorly delimited by the costal margin (definitions vary - a pragmatic approach is to use the nipple line as the upper boundary… in non-obese men at least!).Between the anterior axillary lines bound by the costal margin superiorly and the groin crease distally. These are the 4 regions of the abdomen to consider in penetrating injury: If the wound was caused by a projectile, then a penetrating abdominal injury could result from an entry wound in almost any part of the body.Any wound between the nipple line (T4) and the groin creases anteriorly, and from T4 to the curves of the iliac crests posteriorly is potentially a penetrating abdominal injury.gunshot wounds) and non-projectiles (e.g. Most patients with significant penetrating injury require laparotomy there are differences in the management of projectiles (e.g. organs most affected are : spleen > liver > small and large intestine.Common mechanisms include road traffic crashes, falls, sports injuries and assaults.Assessment of abdominal trauma requires the identification of immediately life-threatening injuries on primary survey, and delayed life threats on secondary survey.Ībdominal trauma is classified as blunt or penetrating, assessment and management is modified accordinglyīlunt abdominal injuries often managed conservatively, though interventional radiology and surgery are indicated for severe injuries
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