Abdominal Trauma

Summary: <br> Step 1: Does This Patient Need Surgery NOW? <br> <br> <br> <br> * Obvious penetrating injury to abdomen* Peritonitis* Hypotensive<br> <br> <br> <br> Step 2: FAST Scan<br> <br> <br> <br> * Performed with bedside ultrasound machine* Blood/intra-peritoneal fluid is hypoechoic (black) in appearance* Four views required* Right upper quadrant* Probe marker points towards patient’s head* “Morrisons Pouch”* Potential space between liver and right kidney* Left upper quadrant* Probe marker towards patient’s head* Most difficult view to obtain* Potential space around spleen and between spleen and left kidney* Suprapubic* Probe marker towards patient’s head* Looking for thin rim of fluid between bladder wall and bowel wall* Subxiphoid* Hold probe flat and aim through liver towards heart* Looking for fluid around heart and evidence of cardiac tamponade<br> <br> <br> <br> Step 3: Consider the Mechanism<br> <br> <br> <br> * Low risk* Low speed MVAs* Falling down only a few steps* High risk* Falling off ladder/roof* High velocity MVA/impact<br> <br> <br> <br> Step 4: Perform Careful Abdominal Exam<br> <br> <br> <br> * Pain* Bruising/Seatbelt sign* Distension* Peritonitis* Rigidity* Rebound* Guarding<br> <br> <br> <br> Step 5: Obtain Imaging if High Risk Mechanism or Abnormal Exam<br> <br> <br> <br> * CT Abdomen/Pelvis with IV contrast* If normal CT scan but you still have clinical concern- ADMIT* Serial abdominal exams* CT notorious for missing small bowel and diaphragmatic injuries<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * Trauma Basics <a href="http://www.emclerkship.com/trauma/">(EM Clerkship)</a>* FAST Examination <a href="https://www.saem.org/cdem/education/online-education/m3-curriculum/bedside-ultrasonagraphy/fast-exam#!#:~:text=%20FAST%20examination%20%201%20Objectives.%20Describe%20the,recommend%20using%20a...%204%20Views.%20%20More%20">(SAEM)</a><br>