Approach to Penetrating Trauma

Lecture Notes

Like all trauma, abdominal trauma is divided into 2 main categories: penetrating and blunt.

The first question to ask in any patient presenting with trauma is if the patient is hemodynamically stable.

The Unstable Patient

If the answer to that question is no, the patient should be redlined to the OR.

The Stable Patient

If the answer to that question is yes, the patient is hemodynamically stable, you now have a little time to do work up and resus the patient.

In the hemodynamically stable patient with penetrating trauma the most important question is whether or not the patient’s peritoneum has been violated.

To evaluate for this you can extend the incision and bluntly dissect down to the base of the puncture wound.

If the peritoneum has been violated the patient will need to go to the OR for an Ex Lap.

If the peritoneum has not been violated you can suture the wound and discharge the patient.

This method is nice because you do not have to expose your patient to a CT scan, which is especially great if the patient is a young female of childbearing age.

It is also preferred to probing the wound, since probing the wound can cause an iatrogenic violation of he peritoneum.


Reference:

Eastern Trauma Association Guidelines
Penetrating Abdominal Trauma, Selective Non-Operative Management of
https://www.east.org/education/practice-management-guidelines/penetrating-abdominal-trauma%2C-selective-non-operative-management-of


Subscribe to the EM Ed by entering your email in the subscription box below.  Don't rely on Facebook to get notifications for new posts.  We only email when a new post is published. No spam.  If you are reading this on your phone, just keep scrolling down to get to the Subscribe box.  

Give us some love by sharing the EM Ed with people you think would like it. Post the lecture on social media. Like and Follow our Facebook Page. Follow us onTwitter. Follow us on Instagram

Approach to Syncope: FA HE HE

Approach to Blunt Abdominal Trauma