Trauma_Emergency

Trauma:

Injury and Trauma can be contributing factors to SBS if the small bowel is damaged to where a large portion must be resected from the abdomen.

Intestinal trauma can be classified as:

-Internal bleeding,

-Intestinal volvulus

-Blunt force trauma to the abdomen.

SBS can be caused by removal of a large portion of the small intestine, which can result in malabsorption of nutrients.

 


Abdominal Trauma


Abdominal trauma is an injury to the abdomen. It may be blunt or penetrating and may involve damage to the abdominal organs. Signs and symptoms include abdominal paintenderness, rigidity, and bruising of the external abdomen. Abdominal trauma presents a risk of severe blood loss and infection. Diagnosis may involve ultrasonographycomputed tomography, and peritoneal lavage, and treatment may involve surgery.[1] Injury to the lower chest may cause splenic or liver injuries.[2]

 


Signs & Symptoms


People injured in traffic accidents may present with a “seat belt sign”, bruising on the abdomen along the site of the lap portion of the safety belt; this sign is associated with a high rate of injury to the abdominal organs.[5] Seatbelts may also cause abrasions and hematomas; up to 30 percent of people with such signs have associated internal injuries.[3] Early indications of abdominal trauma include nauseavomiting, and fever.[6] Blood in the urine is another sign.[5]The injury may present with abdominal paintenderness,[4] distension, or rigidity to the touch, and bowel sounds may be diminished or absent. Abdominal guarding is a tensing of the abdominal wall muscles to guard inflamed organs within the abdomen.

In penetrating injuries, an evisceration (protrusion of internal organs out of a wound) may be present.[7]

Injuries associated with intra-abdominal trauma include rib fracturesvertebral fractures, pelvic fractures, and injuries to the abdominal wall.[8]


Causes


Vehicle accidents are a common cause of blunt abdominal trauma.[3] Seat belts reduce the incidence of injuries such as head injury and chest injury, but present a threat to such abdominal organs as the pancreas and the intestines, which may be compressed against the spinal column.[3] Children are especially vulnerable to abdominal injury from seat belts, because they have softer abdominal regions and seat belts were not designed to fit them.[5] In children, bicycle accidents are also a common cause of abdominal injury, especially when the abdomen strikes the handlebars.[5] Sports injuries can affect abdominal organs such as the spleen and kidneys.[4] Falls and sports are also frequent mechanisms of abdominal injury in children.[5] Abdominal injury can also result from child abuse and is the second leading cause of child abuse-related death, after traumatic brain injury.[6]

Gunshot wounds, which are higher energy than stab wounds, are usually more damaging than the latter.[9] Gunshot wounds that penetrate the peritoneumresult in significant damage to major intra-abdominal structures over 90 percent of cases.[9]


Diagnosis


Diagnostic techniques used include CT scanningultrasound,[1] and X-ray.[4] X-ray can help determine the path of a penetrating object and locate any foreign matter left in the wound, but may not be helpful in blunt trauma.[4] Diagnostic peritoneal lavage is a controversial technique but can be used to detect injury to abdominal organs: a catheter is placed in the peritoneal cavity, and if fluid is present, it is aspirated and examined for blood or evidence of organ rupture.[1] If this does not reveal evidence of injury, sterile saline is infused into the cavity and evacuated and examined for blood or other material.[1]While peritoneal lavage is an accurate way to test for bleeding, it carries a risk of injuring the abdominal organs, may be difficult to perform, and may lead to unnecessary surgery; thus it has largely been replaced by ultrasound in Europe and North America.[1] Ultrasound can detect fluid such as blood or gastrointestinal contents in the abdominal cavity,[1] and it is a noninvasive procedure and relatively safe for the patient.[5] CT scanning is the preferred technique for people who are not at immediate risk of shock, but since ultrasound can be performed right in an emergency room, the latter is recommended for people who are not stable enough to move to CT scanning.[1] However, people with abdominal trauma frequently need CT scans for other trauma (for example, head or chest CT); in these cases abdominal CT can be performed at the same time without wasting time in patient care.[5] Diagnostic laparoscopyor exploratory laparotomy may also be performed if other diagnostic methods do not yield conclusive results.[3]


Treatment & Outcomes


Initial treatment involves stabilizing the patient enough to ensure adequate airway, breathing, and circulation, and identifying other injuries.[4] Surgery may be needed to repair injured organs. Surgical exploration is necessary for people with penetrating injuries and signs of peritonitis or shock.[3] Laparotomy is often performed in blunt abdominal trauma,[1] and is urgently required if an abdominal injury causes a large, potentially deadly bleed.[3] However, intra-abdominal injuries are also frequently successfully treated nonoperatively.[5][4] The use of CT scanning allows care providers to use less surgery because they can identify injuries that can be managed conservatively and rule out other injuries that would need surgery.[4] Depending on the injuries, a patient may or may not need intensive care.[5]

If abdominal injury is not diagnosed promptly, a worse outcome is associated.[1] Delayed treatment is associated with an especially high morbidity and mortality if perforation of the gastrointestinal tract is involved.[12]

Most deaths resulting from abdominal trauma are preventable;[3] abdominal trauma is one of the most common causes of preventable, trauma-related deaths.[4]


References


  1. a b c d e f g h i j k Jansen JO, Yule SR, Loudon MA (April 2008). “Investigation of blunt abdominal trauma”. BMJ 336 (7650): 938–42. doi:10.1136/bmj.39534.686192.80PMC 2335258.PMID 18436949.
  2. ^ Wyatt, Jonathon; Illingworth, RN. Graham, CA. Clancy, MJ. Robertson, CE (2006). Oxford Handbook of Emergency Medicine. Oxford University Press. p. 346. ISBN 978-0-19-920607-0.
  3. a b c d e f g h i j k l m Hemmila MR, Wahl WL (2005). “Management of the Injured Patient”. In Doherty GM. Current Surgical Diagnosis and Treatment. McGraw-Hill Medical. pp. 227–8. ISBN 0-07-142315-X. Retrieved 2008-06-21.
  4. a b c d e f g h i Yeo A (2004). “Abdominal trauma”. In Chih HN, Ooi LL. Acute Surgical Management. World Scientific Publishing Company. pp. 327–33. ISBN 981-238-681-5. Retrieved 2008-06-21.
  5. a b c d e f g h i j k l m n o p q r s Bixby SD, Callahan MJ, Taylor GA (January 2008). “Imaging in pediatric blunt abdominal trauma”. Semin Roentgenol 43 (1): 72–82.doi:10.1053/j.ro.2007.08.009PMID 18053830.
  6. a b c Lichtenstein R, Suggs AH (2006). “Child abuse/assault”. In Olshaker JS, Jackson MC, Smock WS. Forensic Emergency Medicine: Mechanisms and Clinical Management (Board Review Series). Hagerstown, MD: Lippincott Williams & Wilkins. pp. 157–9. ISBN 0-7817-9274-6. Retrieved 2008-06-21.
  7. ^ Chih, p.343
  8. a b c Hemmila, p. 231
  9. a b Chih, pp. 346–348
  10. a b c d Blank-Reid C (September 2006). “A historical review of penetrating abdominal trauma”.Crit Care Nurs Clin North Am 18 (3): 387–401. doi:10.1016/j.ccell.2006.05.007.PMID 16962459.
  11. a b Fabian TC, Bee TK (2004). “Liver and biliary trauma”. In Moore EJ, Feliciano DV, Mattox KL.Trauma. New York: McGraw-Hill, Medical Pub. Division. pp. 637. ISBN 0-07-137069-2. Retrieved 2008-06-21.
  12. a b c d e f g h Visrutaratna P, Na-Chiangmai W (April 2008). “Computed tomography of blunt abdominal trauma in children”. Singapore Med J 49 (4): 352–8; quiz 359. PMID 18418531.
  13. ^ Amal Mattu; Deepi Goyal; Barrett, Jeffrey W.; Joshua Broder; DeAngelis, Michael; Peter Deblieux; Gus M. Garmel; Richard Harrigan; David Karras; Anita L’Italien; David Manthey (2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden, Mass: Blackwell Pub./BMJ Books. pp. 61. ISBN 1-4051-4166-2.
  14. ^ Demetriades D, Velmahos G, Cornell E 3rd, et al. Selective nonoperative management of gunshot wounds of the anterior abdomen. Arch Surg 1997; 132:178–183
  15. ^ Goodman CS, Hur JY, Adajar MA, Coulam CH., How well does CT predict the need for laparotomy in hemodynamically stable patients with penetrating abdominal injury? A review and meta-analysis., AJR Am J Roentgenol. 2009 Aug;193(2):432-7.