![]() ![]() He is awake and protecting his airway, but his abdomen is distended and his blood pressure is 90 palpated, pulse of 118, and respiratory rate of 24. You are in the middle of your shift and overhear an EMS call regarding a trauma patient coming in with lights and sirens: “Onboard we have a 23 year-old male, stabbing victim with a single stab wound to the abdomen, multiple abrasions, contusions and lacerations to the extremities. Tudor, MD, University of IL College of Medicine - Peoria, IL Kaiser Permanente Central Valley, Kaiser Permanente School of Medicine.Įditor: Gregory J. SAEMF/CDEM Innovations in Undergraduate Emergency Medicine Education GrantĬareer Development and Mentorship CommitteeĬDEM Medical Education Fellow Travel ScholarshipĪuthor: Nur-Ain Nadir. Virtual Rotation and Educational ResourcesĮMF/SAEMF Medical Student Research Training Grant 2006 53(2):243–256.Visit us on Twitter LinkedIn Facebook YouTube Instagram Systematic review and meta-analysis of emergency ultrasonography for blunt abdominal trauma. Stengel D, Bauwens K, Sehouli J, et al.Emergency department ultrasound is not a sensitive detector of solid organ injury. Kendall JL, Faragher J, Hewitt GJ, et al. ![]() Performance of helical computed tomography without oral contrast for the detection of gastrointestinal injuries. Holmes JF, Offerman SR, Chang CH, et al.Do we really rely on fast for decision-making in the management of blunt abdominal trauma? Injury. Carter JW, Falco MH, Chopko MS, et al.Clinical policy: Critical issues in the evaluation of adult patients presenting to the emergency department with acute blunt abdominal trauma. American College of Emergency Physicians Clinical Policies Subcommittee on Acute Blunt Abdominal Trauma.Does not exclude intra-abdominal injuryĭiagnostic Tests and Interpretation Diagnostic Tests and Interpretation.Ultrasound is rapid, requires no contrast agents, and is noninvasive.Focused abdominal sonography for trauma (FAST) to detect free intraperitoneal fluid:.Further evaluation of these structures with retrograde urethrogram or cystogram.Fracture of the pelvis and gross hematuria may indicate genitourinary injury.CXR can aid in detection of pneumoperitoneum or ruptured diaphragm.There are few indications for diagnostic peritoneal lavage in a hemodynamically stable patient when CT is readily available.CT is most useful in assessing the need for operative intervention and for evaluating the retroperitoneal space and solid organs.Insert Foley catheter (if no blood at the meatus, no perineal hematoma, and normal prostate exam) to obtain urine and record urinary output.Rectal exam should be done to assess for boney trauma or blood.The limits of the abdomen include the diaphragm superiorly (nipples anteriorly, inferior scapular tip posteriorly) and the intragluteal fold inferiorly and encompass entire circumference.Injury in the retroperitoneal space or intrathoracic abdomen is difficult to assess by palpation.Examine abdomen to detect signs of intra-abdominal bleeding or peritoneal irritation, but the examination is limited in detecting intraperitoneal blood.Primary objective is to determine need for operative intervention.Evaluate and stabilize airway, breathing, and circulation.
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