ABDOMINAL INJURIES.   Term Paper ID:20454 Click to get this paper

Essay Subject: Types, damage, required treatment, evaluation, hemorrhage, trauma, surgery, shock.... More...

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Paper Abstract: Types, damage, required treatment, evaluation, hemorrhage, trauma, surgery, shock. Paper Introduction: Abdominal injuries are common and are the most frequent cause of unnecessary death due to hemorrhage and rupture. Emergency treatment of abdominal injuries or trauma, as with other injuries, begins with assessing the severity and giving immediate care (5:256). It is important to ensure adequate airway. Intubate if necessary, and administer oxygen. The cervical spine should be immobilized if cervical spine injury is possible. The next step is to assess ventilation. Auscultate the chest for the presence of symmetric breath sounds. A search of flail segments and chest wounds should be made, and a thoracostomy as indicated for pneumothorax should be performed. After this, adequacy of circulation should be noted. Palpate for the presence of pulses, look for signs of shock, and stop gross Text of the Paper: The entire text of the paper is shown below. However, the text is somewhat scrambled. We want to give you as much information as we possibly can about our papers and essays, but we cannot give them away for free. In the text below you will find that while disordered, many of the phrases are essentially intact. From this text you will be able to get a solid sense of the writing style, the concepts addressed, and the sources used in the research paper. with assessingthe severity and giving immediate care It to assess ventilation Auscultate the chest for thepresence of symmetric noted Palpate for the presence of pulses look for signs perform emergency thoracotomy for open chest cardiac compressionto relieve tostimuli should be assessed After this and may serve a useful hemostatic function those withseemingly minor abdominal trauma The goal is ideal In the awakeand stable patient patients Diagnostic peritoneal lavage DPL isutilized to prevent celiotomy for prolonged generalanesthesia to repair associated injuries of lavage fluid dependent on center to improve sensitivity abdominal CTin the stable patient has been advocated as need for on-site expertise to evaluate the scan and havenot been of benefit However injuriesare due to penetrating trauma and most patients have exsanguinatinghemorrhages in order to afford access the aorta should be controlled at thediaphragmatic hiatus vessels may be obvious with intra-abdominal bleeding or large hematomas spleen pancreas left colon and stomach medically allows access construction or industrialaccidents Clinical findings depend on the type of as much information as possible from thepolice paramedics the patient elapsedfrom injury to arrival at the emergency will detect many associatedintrathoracic injuries and if serum electrolytes and amylase and tests of renal andhepatic function in which one looks for metabolic acidosis as the customary supportive care as the hematocrit falls below percent monitor urineoutput Insert a nasogastric tube connected to reduce the bowel in the emergency departmentmay infection after penetrating abdominal trauma include celfoxitin chloramphenical clindamycin tobramycin or contrast x-rays are not performed since theseprocedures spent high-velocity missiles or low-velocitybullets oninspection such as a knife Adjunctive diagnostic tests including CTscan and arteriography should must be hospitalized Laparotomy is indicated if peritoneal penetration minor abdominal wounds whichfail to penetrate the posterior rectus mayalso occur with a blunt object oftenassociated with high-speed motor vehicle points of attachment Commoninjuries include duodenal over by aheavy vehicle In the latter cases Blunt abdominal trauma may produce serious injuries that shock syndrome andperitonitis syndrome Associated injuries syndrome is major intra-abdominal trauma has occurred For example percent presenting sign of trauma toorgans such chest x-ray is normal intra-abdominalbleeding must be Fever tachycardia diffuse abdominal pain and tenderness and tothe left upper quadrant In to thespleen documented by a CT also cause anintrahepatic hematoma or liver fracture duodenal trauma colonic splenic rupture treat for shock institute nasogastric suction immediate laparotomy symptoms and signs may be minimal immediatelaparotomy is necessary blunt trauma If there is small intestine perforation treatfor shock is less abundant Injury to the pancreas is bowel and pancreas rupture is similar to that for whom clinical examination was equivocal on twoseparate occasions consisting of four negative and fivenontherapeutic injuries percent Their combined use patients percent Reducing the cell penetrating trauma does not achieve thesame or from blunt trauma Penetrating there may also beassociated injuries Literature Cited Baue A et al Early care of the injured patient J Surg Trunkey D D Abdominal trauma In to hemorrhage and rupture Emergency treatment ofabdominal injuries or immobilized if cervical spine injury is as indicated for pneumothoraxshould be performed of cystralloid solution torestore perfusion now be assessed Thepupillary size and reactivity injuries Do not remove embedded penetrating of suspicion and aggressive evaluation for intra-abdominal specifically Any intra-abdominal injury is potentially dangerous and early statusmay deteriorate rapidly More invasive techniques equivocal abdominal findings or inability to cooperate because of DPL To avoid missing significant injuries the parameter for for retroperitoneal injuries In an attempt toreduce the incidence organ injury The concerns withuse of CT involve its inaccuracy urban setting with rapidtransport pneumatic continues to be one of the greatestchallenges to required forpatients who have hemorrhages It is particularly important encountered rapid examination forhepatic or splenic sources of may controlhemorrhage to allow investigation and control of associated the aorta and venacava may of gunshot wounds and knife wounds Penetrating wounds no well-defined syndromes associated with penetrating traumaother than hemorrhagic shock it was fired theangle of entry the amount of blood the most important tests in is to obtain blood for Other tests that should be performed that hematuria indicates urologic injury emergencyintravenous urogram with intravenous infusion of crystalloid solution Usewhole typed and cross-matched for sixunits of whole blood temporarily managed by placing a sterile petrolatum-impregnated gauze bandage directly is suspected Drugs activeagainst both aerobic and anaerobic perform exploratory surgery can be based onthe history and physical is over the abdomen the missile isassumed to have thereby avoidinglaparotomy With knife wounds if peritoneal inflammation local explorationof the wound to determine if it onscans of the liver spleen or kidneys are equivocal orperitoneal signs are present initially or should behospitalized In addition to causesignificant injury Common injuries resulting from direct impact includesplenic rupture continue to move forward at type of action Shearforces are common in degloving injuries forward tearing nutrient blood vessels Extensive presentation of blunt abdominal trauma spine Symptoms of these associated as unexplained hypotension orshock Hypovolemic toremember regarding blunt trauma is if the patient may present as peritonitis Peritonitisimplies that a hollow viscus has resulting from bluntabdominal trauma It in percent of cases in theremainder surgical repair can repeat CT scan in hours Hospitalize all patients withsuspected gastric injuries are common and areusually found in pairs well as acephalosporin such as small intestine ismost commonly injured bowel are more serious because of intraluminal bacteria theconcentration of and a pancreatogram was used to rule peritoneal lavage performed for suspectedpenetrating abdominal stab wounds In effluentwere compared with the operative findings There identify significant injury in eight patients percent while the and four using the white cell count standard quantitativecriteria for DPL are superior to clinical assessment in and are the mostfrequent cause important taking into account the patient'shistory Shock trauma critical carehandbook Rockville MD Aspen criteria in diagnostic peritoneal lavage CT Appleton Lange Abdominal injuries are common and are the most is important to ensureadequate airway Intubate if necessary breath sounds A search of of shock and stop grossexternal hemorrhage If no pulses tamponade and cross-clamp the aorta has been noted remove all clothingfrom At thistime the patient should be given resuscitative measures and is to detect intra-abdominal surgical with blunt abdominal trauma frequent examination of theabdomen is in patients who otherwise have indicationsfor Low-velocity penetrating wounds such as stab wounds that at the sacrifice ofspecificity DPL is sensitive for intra-abdominal injuries being more specific inidentifying the thepotential for deleterious or disastrous consequences in the rural setting where transport isoften Thoracotomy done in the emergency department to the chest andgroins should by manual compression if thoracotomy has not at the root of the mesentery Accessto the to the suprarenalaorta Penetrating abdominal wounds are classified as high-velocity weapon used the organs injured and the time or witnesses regarding the weapon used ifinjury is from department This information canbe used to predict the type and performed with the patient in the uprightposition it are often performed as well an earlyclue to impending shock assess adequacy of ventilation and stated above adequateventilation administering supplemental oxygen or if more than L of crystalloid to intermittent suction todrain stomach contents and to assess possible cause further injury Antimicrobial prophylaxis should gentamicin penicillin andmetronidazole Almost all patients with penetrating are not helpful in determining the need such as air gun pellets will not penetrate the buried to the hilt in the abdomen be considered to determine the need forsurgery is documented or stronglysuspected based on an sheath may have their woundstreated and This may be caused by direct impact deceleration rotary accidents and falls from heights and aortic rupture Rotary forces also instance as the vehicle passes over theabdominal aredifficult to diagnose because of concerned with related injuries suchas rib fractures pelvic fractures abdominal of patients with fractures of the as the spleen liver or assumed until the contrary is proved by laparotomy peritoneal ileus are the commonest findings of this patients with pathologically enlarged spleens such as from mononucleosis splenic scan and with minimal blood loss can trauma pancreatic trauma and possibly gastric injury to control hemorrhage and reduce for duodenal perforation the mortality rate isnearly and start antimicrobial prophylaxis Immediate laparotomy shouldalso be performed uncommon and difficultto diagnose since the smallintestine Recent research has noted the unreliability underwent diagnostic peritoneal lavage DPL prior tolaparotomy The operations Use of the standard quantitative resulted in three missed injuries percent Two threshold level to exclude missed injuries would diagnostic accuracy as in blunt abdominal trauma trauma most oftencauses hemorrhages and blunt trauma most often causes E Multiple organ failure Baltimore Mosby Year Book Dunham Toronto G C Decker Inc Muckart D J Ho M T Saunders C trauma as with other injuries begins possible The next step is After this adequacy of circulation should be If rapid fluid administration fails to resuscitate thepatient to light and the level of responsiveness objects because they may be blockinginjured blood vessels trauma are indicated in all injured patients even surgicalintervention prior to a deleterious systemic impact are required forunstable or noncompliant CNSinjury drug-impaired sensorium or the need a positivered cell count is lowered to to per militer of nontherapeutic celiotomies the use of in detecting early pancreatic and hollowviscus injury the antishock garments for intra-abdominal hemorrhage the surgeon managing trauma The majority of these to drape allmajor-trauma patients widely bleeding should be undertaken and ifrequired for continued shock vascularinjuries Injuries of the mesenteric be more difficult to obtain Mobilization of the may occuralso in the course of bomb attacks or in It is important to obtain lost at the scene and the time evaluating thevictim of abdominal trauma The chest x-ray CBC and typing and cross-matching Measurements of include arterial blood gasmeasurements and pH cystogram or urethrogram may be required After blood typed and cross-matched when Next insert a Foley catheter to over the bowel and covering it with asterile dressing Attempts organisms are required Drugs that helpprevent examination in most cases It is imperative thatperitoneal lavage entered the abdomen and exploratory laparotomy isindicated Very rarely peritoneal penetration is not obvious is deep enough to have penetrated theperitoneum may be justified All patients with penetrating abdominal trauma if they develop or ifperitoneal lavage is positive Patients with penetrating abdominal trauma abdominal injury and liver fractures Deceleration injuries are most decreasingvelocity tearing vessels and tissues from or when the victim is run soft tissue loss is common insuch are categorizedas such associated injuries syndrome hypotensive injuriesshould around a suspicion that shock may be the sole has unexplainedhypotension or shock and the been disrupted or that the pancreas hasbeen injured may also occur as a result of penetrating trauma save the spleen Minor injuries or documented splenic rupture Blunt trauma may such as entry and exit wounds For cefazolin Duodenal injury diagnosis may bedifficult since early following penetrating abdominal trauma but rarelyinjured in particulate matter is greater and the blood supply to theorgan out apancreatic rupture However emergency treatment in general forlarge this study patients withabdominal stab wounds in were positive and nineunnecessary laparotomies the latter standard white cell count missed six alone producing a combined false-positive result in four patients withequivocal findings their use in of unnecessary death Abdominal injuries may be frompenetrating trauma to determine the extent of the injury since Publishers Inc Drucker T B performed forsuspected penetrating abdominal stab wounds Am frequent cause ofunnecessary death due and administer oxygen Thecervical spine should be flail segments and chestwounds should be made and a thoracostomy are present insert two large-boreintravenous lines and rapidly administer L The neurological status of the patient should the patient and quickly examine the entire body for obvious treatment forshock A high degree pathology not to delineate the injury adequate Abdominal findings may develop and clinical exploration This includes patients with unexplained loss of blood penetrate anterior abdominal fascia are alsoevaluated with but is notspecific and is inaccurate source and degree of solid if used in ahemodynamically unstable patient Finally in the prolonged they may be of some benefit Abdominal vascular injury oroperating room to control the descending thoracic aorta may be vascular control be required When massive hemoperitoneum is precededlaparotomy Rapid plenectomy or packing of a liver injury portal or retroperitoneal vasculature such as or low-velocity In civilian practice penetrating abdominal injuries consistmostly elapsed from injury to hospitalization There are a criminal act the distance from which severity of injuries Chest x-rays are one of may show free peritoneal air below the diaphragm Also important and may be helpful insubsequent management of seriously ill patients urinalysis since it is possible if necessary hypovolemiashould be corrected solution is required to maintainadequate blood pressure Blood should be gastric injury Obviousevisceration should be be startedimmediately if small or large bowel injury abdominal injuries will requirelaparotomy The decision to for laparotomy If the wound is from gunshot and peritoneum Thiscan be confirmed by exploring the wound locally and and thepatient does not have signs of especially if there is severe pelvic bleeding or findings estimate of the missile tract if hypovolemia be discharged All patients with gunshot wounds forces or shear forces Direct impact may As the body impacts the organs tend tocause tearing injuries resulting from a tumbling cavity the skin and subcutaneous tissues are pushed their insidious clinical manifestations The general modes of wall injuries or fracturesof the thoracic or lumbar left lower ribshave ruptured spleens Intra-abdominal injuries may present kidneys The most important rule lavage or CT scan Blunt abdominal trauma condition Rupture of the spleen is the most common injury rupture may occur from relativelytrivial injury Splenectomy is required be managedmonoperatively These patients require hospitalization close observation and a the stomach is rarelyinjured by blunt trauma but penetrating peritoneal soilage Antimicrobial prophylaxis is usually administered as percent if the operation is delayed The to minimize soilage and control hemorrhage Injuries tothe large symptoms may be minimal Recently an uppergastrointestinal tract endoscopy of standard quantitativecriteria in diagnostic red and white blood cell counts of the lavage criteria forred cell in DPL failed to false-positive results occurred using the red cell countalone increasethe rate of unnecessary laparotomies Although the In conclusion abdominal injuries are common ruptures Carefulexamination of the patient is M C Cowley R A J McDonald M A Unreliability of standardquantitative E eds Current emergency diagnosis treatment rd ed Norwalk with assessingthe severity and giving immediate care It to assess ventilation Auscultate the chest for thepresence of symmetric noted Palpate for the presence of pulses look for signs perform emergency thoracotomy for open chest cardiac compressionto relieve tostimuli should be assessed After this and may serve a useful hemostatic function those withseemingly minor abdominal trauma The goal is ideal In the awakeand stable patient patients Diagnostic peritoneal lavage DPL isutilized to prevent celiotomy for prolonged generalanesthesia to repair associated injuries of lavage fluid dependent on center to improve sensitivity abdominal CTin the stable patient has been advocated as need for on-site expertise to evaluate the scan and havenot been of benefit However injuriesare due to penetrating trauma and most patients have exsanguinatinghemorrhages in order to afford access the aorta should be controlled at thediaphragmatic hiatus vessels may be obvious with intra-abdominal bleeding or large hematomas spleen pancreas left colon and stomach medically allows access construction or industrialaccidents Clinical findings depend on the type of as much information as possible from thepolice paramedics the patient elapsedfrom injury to arrival at the emergency will detect many associatedintrathoracic injuries and if serum electrolytes and amylase and tests of renal andhepatic function in which one looks for metabolic acidosis as the customary supportive care as the hematocrit falls below percent monitor urineoutput Insert a nasogastric tube connected to reduce the bowel in the emergency departmentmay infection after penetrating abdominal trauma include celfoxitin chloramphenical clindamycin tobramycin or contrast x-rays are not performed since theseprocedures spent high-velocity missiles or low-velocitybullets oninspection such as a knife Adjunctive diagnostic tests including CTscan and arteriography should must be hospitalized Laparotomy is indicated if peritoneal penetration minor abdominal wounds whichfail to penetrate the posterior rectus mayalso occur with a blunt object oftenassociated with high-speed motor vehicle points of attachment Commoninjuries include duodenal over by aheavy vehicle In the latter cases Blunt abdominal trauma may produce serious injuries that shock syndrome andperitonitis syndrome Associated injuries syndrome is major intra-abdominal trauma has occurred For example percent presenting sign of trauma toorgans such chest x-ray is normal intra-abdominalbleeding must be Fever tachycardia diffuse abdominal pain and tenderness and tothe left upper quadrant In to thespleen documented by a CT also cause anintrahepatic hematoma or liver fracture duodenal trauma colonic splenic rupture treat for shock institute nasogastric suction immediate laparotomy symptoms and signs may be minimal immediatelaparotomy is necessary blunt trauma If there is small intestine perforation treatfor shock is less abundant Injury to the pancreas is bowel and pancreas rupture is similar to that for whom clinical examination was equivocal on twoseparate occasions consisting of four negative and fivenontherapeutic injuries percent Their combined use patients percent Reducing the cell penetrating trauma does not achieve thesame or from blunt trauma Penetrating there may also beassociated injuries Literature Cited Baue A et al Early care of the injured patient J Surg Trunkey D D Abdominal trauma In to hemorrhage and rupture Emergency treatment ofabdominal injuries or immobilized if cervical spine injury is as indicated for pneumothoraxshould be performed of cystralloid solution torestore perfusion now be assessed Thepupillary size and reactivity injuries Do not remove embedded penetrating of suspicion and aggressive evaluation for intra-abdominal specifically Any intra-abdominal injury is potentially dangerous and early statusmay deteriorate rapidly More invasive techniques equivocal abdominal findings or inability to cooperate because of DPL To avoid missing significant injuries the parameter for for retroperitoneal injuries In an attempt toreduce the incidence organ injury The concerns withuse of CT involve its inaccuracy urban setting with rapidtransport pneumatic continues to be one of the greatestchallenges to required forpatients who have hemorrhages It is particularly important encountered rapid examination forhepatic or splenic sources of may controlhemorrhage to allow investigation and control of associated the aorta and venacava may of gunshot wounds and knife wounds Penetrating wounds no well-defined syndromes associated with penetrating traumaother than hemorrhagic shock it was fired theangle of entry the amount of blood the most important tests in is to obtain blood for Other tests that should be performed that hematuria indicates urologic injury emergencyintravenous urogram with intravenous infusion of crystalloid solution Usewhole typed and cross-matched for sixunits of whole blood temporarily managed by placing a sterile petrolatum-impregnated gauze bandage directly is suspected Drugs activeagainst both aerobic and anaerobic perform exploratory surgery can be based onthe history and physical is over the abdomen the missile isassumed to have thereby avoidinglaparotomy With knife wounds if peritoneal inflammation local explorationof the wound to determine if it onscans of the liver spleen or kidneys are equivocal orperitoneal signs are present initially or should behospitalized In addition to causesignificant injury Common injuries resulting from direct impact includesplenic rupture continue to move forward at type of action Shearforces are common in degloving injuries forward tearing nutrient blood vessels Extensive presentation of blunt abdominal trauma spine Symptoms of these associated as unexplained hypotension orshock Hypovolemic toremember regarding blunt trauma is if the patient may present as peritonitis Peritonitisimplies that a hollow viscus has resulting from bluntabdominal trauma It in percent of cases in theremainder surgical repair can repeat CT scan in hours Hospitalize all patients withsuspected gastric injuries are common and areusually found in pairs well as acephalosporin such as small intestine ismost commonly injured bowel are more serious because of intraluminal bacteria theconcentration of and a pancreatogram was used to rule peritoneal lavage performed for suspectedpenetrating abdominal stab wounds In effluentwere compared with the operative findings There identify significant injury in eight patients percent while the and four using the white cell count standard quantitativecriteria for DPL are superior to clinical assessment in and are the mostfrequent cause important taking into account the patient'shistory Shock trauma critical carehandbook Rockville MD Aspen criteria in diagnostic peritoneal lavage CT Appleton Lange If this paper is not what you are looking for, you can search again: Search for: or Click here to request an essay written just for you.

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