traumatic brain injury and Abdominal Injuries.pptx

most common cause of death in young men is traumatic brain injury

1. Prepared By Dr. abdulhaq MS Abdominal Injuries

2. Abdominal Injuries Types of Abdominal injuries: Penetrating ( more common in urban areas .) Blunt ( Blunt injuries predominate in rural areas ) The mechanism of injury in blunt trauma is rapid deceleration, parenchymal fracture in noncompliant organs such as the liver, spleen, pancreas, and kidneys are at greater risk of injury. Occasionally , hollow viscous organs may be injured, with the duodenum and urinary bladder being particularly susceptible.

3. Blunt Abdominal Trauma The small bowel occupies a large portion of the total abdominal volume and is more likely to be injured by penetrating trauma. Most blunt abdominal injuries are related to Motor vehicle accidents . The use of restraints has been associated with a decrease in the incidence of head, chest , and solid organ injuries. Their use may be associated with pancreatic , mesenteric, and intestinal injuries due to organ compression against the spinal column.

4. Blunt Abdominal Trauma These injuries should be considered in patients who have signs of seat belt-related contusions of the abdominal wall. Internal abdominal injury may be present in as many as 30% of these cases. In any abdominal trauma, hemoperitoneum may not manifest clinical signs of peritoneal irritation, particularly in patients with other distracting injuries or depressed mental status . Retroperitoneal injury may be more subtle and difficult to diagnose during the initial evaluation.

5. Blunt Abdominal Trauma Deaths from abdominal trauma result largely from early severe hemorrhage and coagulopathy from later sepsis . Most deaths from abdominal trauma are preventable . after physical examination the initial diagnostic evaluation includes bedside FAST and portable radiographs of the pelvis and chest to assess for other potential sites of bleeding . In unstable patients who cannot be adequately evaluated with FAST due to size, technical problems, or subcutaneous air, diagnostic peritoneal lavage is warranted.

6. Blunt Abdominal Trauma After the initial FAST examination, patients who are stable or who respond to initial fluid resuscitation should have a CT scan of the abdomen and pelvis to evaluate for intra-abdominal and retroperitoneal injuries . Patients with persistent hypotension requiring fluid and blood resuscitation in the face of a positive FAST or diagnostic peritoneal lavage should be transported to the operating room emergently for exploratory laparotomy.

7. Blunt Abdominal Trauma In some cases, dramatic physical findings may be due to abdominal wall injury in the absence of intraperitoneal injury . If the results of diagnostic studies are equivocal, diagnostic laparoscopy or exploratory laparotomy should be considered, since they may be lifesaving if serious injuries are identified early. Evaluation always includes a comprehensive physical examination with pelvic and rectal examinations. included and may require specific laboratory and radiologic tests (eg, retrograde urethrogram or cystogram, rigid sigmoidoscopy, abdominal CT). Serial physical examinations may be necessary to detect subtle findings.

8. Penetrating Abdominal Injury Exploration for the Pt present with shock or ongoing resuscitation severe and early shock cause by Lacerations of major blood vessels or the liver can cause. Penetrating injuries of the spleen, pancreas , or kidneys usually do not bleed massively unless a major vessel to the organ (eg, the renal artery ) is damaged. Bleeding must be controlled promptly with packing and appropriate clamping for vascular control.

9. Penetrating Abdominal Injury A patient in shock with a penetrating injury of the abdomen who does not respond to 2 L of crystalloid fluid resuscitation should be operated on immediately following chest x-ray and switched blood product resuscitation . Patients with hollow visceral injuries may need exploration when. Abdominal Tenderness Leukocytosis Fever appearing several hours following injury are keys to early diagnosis.

10. Penetrating Abdominal Injury All surgeons agree that patients with signs of peritonitis or hypovolemia should undergo surgical exploration. But operative treatment is less certain for patients with no signs of peritonitis or sepsis who are cardiovascularly stable . Most stab wounds of the lower chest or abdomen should be explore. Penetrating Non Penetrating a delay in treatment of a hollow viscous perforation can result in severe sepsis. Laparoscopy has a role in the evaluation of penetrating injuries in experienced hands

11. Penetrating Abdominal Injury All gunshot wounds of the lower chest and abdomen should be explored, because the incidence of injury to major intra-abdominal structures exceeds 90% in such cases . unless there is a likely superficial scything wound,