Initial Evaluation of the Patient with Blunt Abdominal Trauma

doi:10.1016/S0039-6109(16)45126-1

Surgical Clinics of North America

Volume 70, Issue 3, June 1990, Pages 495-515

https://doi.org/10.1016/S0039-6109(16)45126-1 Get rights and content

The approach to evaluation of blunt abdominal trauma is based on the patient's physiologic status, injury mechanism, associated extra-abdominal trauma, and age. Diagnostic peritoneal lavage and computed tomography of the abdomen are the primary diagnostic adjuncts, but ultrasonography may emerge as a useful triage tool. Pediatric patients, pregnant women, and the elderly have unique characteristics that modify initial management.

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Cited by (38)

Early embolisation in non-operative management of blunt splenic injuries: A retrospective multicentric study
2008, Journal de Chirurgie
But de l’étude : l’embolisationsplénique s’est développée récemmentpour le traitement non opératoire des traumatismes de larate. Les indications sont encore variées selon les équipes,et des études sont nécessaires pour évaluerles résultats de cette technique en France.
Patients et méthode : de mars 2000 à avril 2006,22 patients (17 hommes et 5 femmes) d’un âgesupérieur ou égal à 15 ans (âgemoyen 29 ans, extrêmes 15 à 59 ans)ont eu une embolisation splénique entre deux heures et15 jours après un traumatisme spléniqueclassé Moore II (3 cas), Moore III(12 cas) et Moore IV (7 cas), dans 6 CentresHospitaliers Universitaires (CHU) français ayant une expertiseen traumatologie viscérale. L’embolisation a été réaliséedans un délai inferieur ou égal à 4 heuresaprès l’admission au CHU de référencedans 50 % des cas. Les principales indicationsd’embolisation étaient : l’extravasationde produit de contraste en tomodensitométrie (9 cas,41 %) ; la dégradation hémodynamiqueet/ou déglobulisation (6 cas, 27 %) ;les pseudoanévrysmes précoces (5 cas,23 %) et ; une embolisation « derencontre » (2 cas, 9 %).
Résultats : la mortalité a été nulle,9 patients ont eu des suites compliquées (41 %), principalementreprésentées par un épanchement pleuralgauche (n = 6, 27 %). Deux splénectomiesont été réalisées aprèsl’embolisation (une pour poursuite de l’hémorragie, unepour nécrose), soit un taux de sauvetage de la rate de91 %.
Conclusions : l’embolisation spléniqueest une technique qui permet de diminuer le taux de splénectomiepour traumatisme, au prix d’une morbidité spécifiquemodérée.
Aim of the study: Splenic artery embolization has beenused as an adjunct to the non-surgical management of blunt splenicinjury. No consensus on its indications has emerged from the literature.This multicentric study aimed to evaluate the results of this technique inFrance.
Patients and methods: Between March 2000 andApril 2006, 22 patients older than 15 yearsof age (mean age 29, range: 15-59) with splenicv rupture due toblunt trauma underwent splenic artery embolization in six Level ITrauma Centers in France. Splenic rupture was classified Moore IIin 3 cases, Moore III in 12 cases, andMoore IV in 7 cases. Angiography was performedwithin 4 hours of admission in half of the cases. The main indicationsfor splenic artery embolization were: extravasation of contrastmedium on CT scan (10 cases, 45%); early pseudo-aneurysm(6 cases, 23%); hypotension despite fluid resuscitationand/or progressive need for transfusion (5 cases,22%).
Results: There was no mortality. Nine patients experiencedcomplications (41%) including 6 (27%) who developedleft pleural effusion. Two patients eventually underwent splenectomy(one for persistent hemorrhage, one for splenic necrosis). The overallsplenic salvage rate was 91%.
Conclusion: Splenic artery embolization is a valuabletechniche that hels to lower the rate of splenectomy for traumaticsplenic rupture with relatively low morbidity.
Evaluation, Stabilization, and Initial Management after Multiple Trauma
2005, Pediatric Critical Care, Third Edition
Gastrointestinal surgery and pregnancy
2003, Gastroenterology Clinics of North America
How distracting is distracting pain?
2003, American Journal of Emergency Medicine
The study was to determine the effect of preexisting pain on the perception of a painful stimulus. We conducted a cross-section study at an urban ED using convenience sampling. Adult patients who had a 20-g IV catheter placed as part of their ED care were eligible for the study. Patients were excluded for the following reasons: more than one IV attempt, altered mental status, visual impairment, intoxication, or a physical abnormality at the IV site. Patients were asked to indicate on a 10-cm visual analog scale (VAS) the amount of pain they had at baseline immediately before IV placement. They were then asked to indicate on a separate VAS the amount of pain caused by the IV placement. Correlation between baseline pain and pain of the IV was assessed using Pearson's ρ. One hundred patients were enrolled in the study. The pain of IV placement did not differ significantly by gender, race, who placed the IV, or the location of the IV. The correlation between baseline pain and pain of the IV placement was poor (ρ =.14, confidence interval:−.06-.33). The response to a standardized painful stimulus among ED patients does not correlate highly with the severity of preexisting pain. (Am J Emerg Med 2003;21:43-44. Copyright 2003, Elsevier Science (USA). All rights reserved.)
Management of a comatose blunt multiple trauma patient
2002, Annales Francaises d'Anesthesie et de Reanimation
Objectif : Mise au point sur la stratégie diagnostique lors de la réception en unité de soins intensifs d’un patient adulte dans le coma victime d’un polytraumatisme fermé.
Source de données : Recherche sur la base de données Pubmed® (721 références) des études de langue française et anglaise ayant fait l’objet d’une publication entre 1990-2000 et sur des ouvrages spécialisés sur la prise en charge du traumatisme grave. Quelques études antérieures ont été citées du fait de l’absence de nouvelles données sur leur thème.
Sélection des données : Les articles ont été sélectionnés en fonction de leur qualité et leur originalité. Les critères de sélection ont été basés essentiellement sur la reproductibilité des résultats exposés. Les études les plus récentes et les plus représentatives ont été citées. Les mots clés initiaux ont été : management of multiple trauma.
Synthèse des données : Les premières heures de prise en charge du traumatisé grave sont fondamentales. Il est impératif d’adresser le patient dans une structure apte à le recevoir. Si l’instabilité hémodynamique prédomine, la régulation doit le diriger vers l’hôpital le plus proche possédant un bloc opératoire. Dès que la stabilité hémodynamique est restaurée, il convient d’orienter ce type de patient vers des structures possédant un plateau une technique de haut niveau. La réception d’un polytraumatisé nécessite une équipe pluridisciplinaire composée d’un anesthésiste-réanimateur, d’un chirurgien viscéral, d’un neurochirurgien, d’un chirurgien orthopédiste et d’un radiologue, agissant selon des protocoles conjointement rédigés. Le bilan lésionnel à entreprendre doit avoir deux propriétés : qualité des examens obtenus et rapidité de réalisation. La tomodensitométrie du corps entier, « plus grand dénominateur commun » pour l’exploration de l’ensemble des appareils, répond à de telles exigences.
Objective: To review the diagnostic strategy of management of multiple trauma patient during the first hours.
Data sources: Extraction from Pubmed® database of French and English articles on the management of multiple trauma patient published for ten years.
Data selection: The collected articles were reviewed and selected according to their quality and originality. The more recent data were selected.
Data synthesis: The first hours of management of multiple trauma patients are a particular challenge. The first dilemma is to drive the patient toward an adequate structure. In case of poor haemodynamic tolerance, the patient will be drive in the nearest hospital. When haemodynamic parameters are restored, multiple trauma patient has to be receive in a high level hospital by a trained medical team with an anesthesiologist, intensivist, neurosurgeon, general surgeon and radiologist. The initial assessment may have two priorities : quality and speed. The total body CT scan is actually the answer to these priorities.
Fracture of the pancreas in two patients after a go-kart accident
2001, HPB
Citation Excerpt :
Serum amylase levels are neither specific nor sensitive [3,4,6,15,16], though in the present cases the rising values from initial normality were very helpful. Ultrasound scan is routinely used at present in many accident and emergency departments and is useful for the detection of free intraperitoneal fluid or a large haematoma, but its ability to show a specific injury to the pancreatic duct is limited [5]. The accuracy of CT in diagnosing trauma to the pancreas is lower than for other injured abdominal viscera [17].
After blunt abdominal trauma, an isolated injury to the pancreatic duct is uncommon. Physical signs and laboratory parameters are often inaccurate, and missing this diagnosis can cause serious clinical problems.
Two young women (aged 18 and 20 years) are reported who sustained isolated trauma to the pancreatic duct in go‐kart accidents. Each patient sustained a fracture of the pancreas. This injury was diagnosed only after a period of clinical observation with repeated laboratory parameters, ultrasound and CT scan. Pancreatic tissue was conserved by performing a pancreaticojejunostomy.
After any episode of blunt abdominal trauma, isolated injury to the pancreatic duct should be considered. Serum analysis, ultrasonography and CT scanning can be helpful in early diagnosis. Preservation of pancreatic tissue can be achieved with a good clinical outcome.

View all citing articles on Scopus

: Address reprint requests to: Ernest E. Moore, MD, Department of Surgery, Denver General Hospital, 777 Bannock Street, Denver, CO 80204-4507

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Initial Evaluation of the Patient with Blunt Abdominal Trauma

J Pediatr Surg

Accid Anal Prev

Am J Surg

Ann Emerg Med

Am J Obstet Gynecol

J Pediatr Surg

Ann Emerg Med

Ann Emerg Med

Am J Surg

Med Clin North Am

Am J Surg

Accid Anal Prev

Am J Surg

Am J Obstet Gynecol

Value of quantitative cell count and amylase activity of peritoneal lavage fluid

J Trauma

Abdominal injuries sustained in severe traffic accidents by seatbelt wearers

J Trauma

Diagnostic and interventional radiology in trauma

Serum amylase and its isoenzyme—a clarification of their implications in trauma

J Trauma

Computerized axial tomography of pelvic ring fractures

J Trauma

Is peritoneal lavage for the diagnosis of hemoperitoneum safe?

Arch Surg

Intestinal perforation due to blunt trauma in children in an era of increased nonoperative treatment

J Trauma

Upper abdominal trauma: Pitfalls in CT diagnosis

Radiology

Major blunt abdominal trauma due to child abuse

J Trauma

Report of the panel on magnetic resonance imaging: Magnetic resonance imaging of the abdomen and pelvis

JAMA

Blunt abdominal trauma: A 5-year analysis of 870 patients requiring celiotomy

Ann Surg

Diagnosis and management of blunt abdominal trauma

Ann Surg

The use of computerized axial tomography versus peritoneal lavage in the evaluation of blunt abdominal trauma: A prospective study

Surgery

Geriatric trauma

Aggressive trauma care benefits the elderly

J Trauma

Blunt abdominal trauma

J Trauma

Computed tomography of the pelvis in patients with multiple injuries

J Trauma

Progress in pediatric trauma

World J Surg

A prospective study of 91 patients undergoing both computer tomography and peritoneal lavage following blunt abdominal trauma

J Trauma

Computed tomography in blunt abdominal trauma

Arch Surg

Patterns of injury

Radiology of abdominal trauma

JAMA

Gastrointestinal disruption: The hazard of nonoperative management in adults with blunt abdominal injury

J Trauma

Duodenal injury—analysis of common misconceptions in diagnosis and treatment

Ann Surg

Abdominal injuries in automobile accidents: Review of care of fatally injured patients

J Trauma

The value of sonography in the diagnosis and follow-up of patients with blunt renal trauma

Br J Urol

The value of hepatobiliary scanning in complex liver trauma

J Trauma

The diagnostic superiority of computerized tomography

J Trauma

Diagnostic peritoneal lavage in the management of blunt abdominal trauma: A reassessment

J Trauma

Intravenous pyelography in abdominal trauma

J Trauma

Sonography vs. peritoneal lavage in blunt abdominal trauma

J Trauma