Abdominal Trauma ATCN Questions and Answers Latest 2024 Update, Exams of Health sciences

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Abdominal Trauma ATCN Questions and Answers Latest

2024 Update

Physical Exam: Inspection - Correct Answer 1. fully undress patient

2. examine anterior and posterior abdomen
3. examine chest and flank
4. inspect perineum, scrotum, and perianal area
5. logroll patient to inspect ack AFTER INSPECTION, COVER THE PATIENT TO PREVENT HYPOTHERMIA Signs of Pelvic Fracture - Correct Answer 1. evidence of ruptured urethra (scrotal hematoma or blood at the urethral meatus)
6. discrepancy in limb length
7. rotation deformity of a leg without obvious fracture IN PATIENTS WITH THESE SIGNS, AVOID MANUALLY MANIPULATING THE PELVIS Hypotension and pelvic fracture = high mortality Therefore... - Correct Answer Sound, rapid diagnosis and treatment are critical to patient outcome Pelvic assessment key points - Correct Answer 1. diagnose pelvic hemorrhage and treat without delay
8. unexplained hypotension may be the only sign of pelvic disruption
9. place a pelvic binder of pelvic fractures, hypotension, and no other source of blood loss
10. avoid pelvic manipulation and distraction
11. may gently palpate the bony pelvis for tenderness, not stability Pelvic Farrctures: Initial Management - Correct Answer 1. hemorrhage control a. emergent: stabilization, with sheet, binder, internal rotation or lower extremities b. definitive: angiographic embolization, operative hemorrhage control
12. fluid resuscitation (avoid hypothermia)
13. early transfer Signs of urethral injury - Correct Answer 1. blood at the urethral meatus, scrotal and perineal ecchymosis Rectal exam (blunt trauma) - Correct Answer 1. assess sphincter tone and rectal mucosal integrity, and identify palpale fractures of pelvis

rectal exam (penetrating trauma) - Correct Answer assess sphincter tone and look for gross blood Vaginal Exam: Trauma - Correct Answer Perform when injury supsected; bony fragments from pelvic fractures and penetrating wounds can cause lacerations Gluteal exam: Trauma - Correct Answer look for penetrating injuries that can result in significant intra-abdominal injuries (e.g., gunshot and stab wounds) GASTRIC TUBE GOALS: - Correct Answer 1. relieve gastric dilation and decompress stomach GASTRIC TUBE Hints - Correct Answer 1. can prevent aspiration, but can trigger vomiting

2. blood in gastric contents suggests esophageal or upper gastrointestinal injury
3. in patients with facial fractures or possible basilar skull fracture, insert through mouth URINARY CATHETER GOALS: - Correct Answer 1. relieve retention, identify bleeding, monitor urinary output, decompress bladder URINARY CATHETER HINTS - Correct Answer 1. if FAST is an option, wait to place catheter
4. confirm intact urethra before placing catheter
5. gross hematuria indicates genitourinary tract trauma
6. retrograde urethrogram if patient cannot void, require pelvic binder, blood at the meatus, scrotal hematoma, perineal ecchymosis PITFALL: in a patient with midface fractures, a nasogastric tube can pass into the sinuses and cranial cavity - Correct Answer Solution: avoid a nasogastric tube in patients with midface injury; instead use an orogastric tube PITFALL: Pediatric patients have high rates of acute gastric distention following trauma

• Correct Answer Solution: a gastric tube may be beneficial in pediatric patients to reduce the risk of aspiration and vagal stimulation PITFALL: Passage of a gastric tube may be impossible in patients with hiatal hernias (more common in older adults) - Correct Answer Solution: to avoid iatrogenic injury, do not continue to attempt nasogastric tube placement if several attempts are unsuccessful. Eventual placement may require radiologic or other assistance. Physical Findings that necessitate further abdominal evaluation - Correct Answer 1. altered sensorium

2. altered sensation
3. injury to adjacent structures (lower ribs, pelvis, lumbar spine)
4. equivocal physical examination

5. prolonged loss of contact with patient anticipated (general anesthesia, lengthy radiographic studies)
6. seat-belt sign with suspicion of bowel injury Focused Assessment with Sonography for Trauma (FAST): ADVANTAGES - Correct Answer 1. early operative determination
7. noninvasive
8. performed rapidly
9. repeatable
10. no need for transport out of resuscitation area Focused Assessment with Sonography for Trauma (FAST): DISADVANTAGES - Correct Answer 1. operator-dependent
11. bowel gas and subcutaneous air distort images
12. can miss diaphragm, bowel, and pancreatic injuries
13. does not completely assess retroperitoneal structures
14. does not visualize extraluminar air
15. body habitus can limit image clarity Focused Assessment with Sonography for Trauma (FAST): INDICATIONS - Correct Answer 1. abnormal hemodynamics in blunt abdominal trauma
16. penetrating abdominal trauma without other indications for immediate laparotomy PITFALL: False negative FAST exam - Correct Answer 1. recognize that obesity can degrade images obtained with FAST
17. maintain a high index of suspicion
18. use alternative diagnostic testing and/or repeat evaluation(s)
19. recognize that FAST is insensitive for the diagnosis of hollow visceral injury Diagnostic Peritoneal Lavage (DPL): ADVANTAGES - Correct Answer 1. early operative determination
20. performed rapidly
21. can detect bowel ijury
22. no need for transport out of resuscitation area Diagnostic Peritoneal Lavage (DPL): Disadvantages - Correct Answer 1. invasive
23. risk of procedure-related injury
24. requires gastric and urinary decompression for prevention of complications
25. not repeatable
26. interferes with interpretation of subsequent CT or FAST Diagnostic Peritoneal Lavage (DPL): INDICATIONS - Correct Answer 1. abnormal hemodynamics in blunt abdominal trauma
27. penetrating abdominal trauma without other indications for immediate laparotomy Computed Tomography (CT): Advantages - Correct Answer 1. anatomic diagnosis

2. noninvasive
3. repeatable
4. visualizes retroperitoneal structures
5. visualizes bony and soft-tissue structures
6. visualizes extraluminal air Computed Tomography (CT): Disadvantages - Correct Answer 1. higher cost and longer time
7. radiation and IV contrast exposure
8. can miss diaphragm injuries
9. can miss some bowel and pancreatic injuries
10. requires transport out of resuscitation area Computed Tomography (CT): Indications - Correct Answer 1. normal hemodynamics in blunt or penetrating abdominal trauma
11. penetrating back/flank trauma without other indications for immediate laparotomy Other Contrast studies: (Do not delay treatment or transfer) - Correct Answer 1. urethrography
12. cystography
13. intravenous pyelogram
14. gastrointestinal contrast studies