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Old 05-25-2012
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Surgery Abdominal gun shot wound management?

Hi all:

If today patients come in with stable hemodynamic state plus abdominal gun shot wound, do we still need to get exploratory laparotomy?

Thank you!
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Old 05-25-2012
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Yes every gunshot = exploratory lap
This also apply for most of the penetrative injury with some exception, which i dont remember :d
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Old 05-25-2012
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indication for laprotomy in abdomen trauma patient
  • gun shot wound
  • blunt wound penetrating the abdomen wall [ not the small knife in fat lady]
  • any sign of peritonitis
  • unstable patient....u go for FAST scan prior to make sure that abdomen has blood.
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Old 05-25-2012
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Quote:
Originally Posted by chienpolska View Post
Hi all:

If today patients come in with stable hemodynamic state plus abdominal gun shot wound, do we still need to get exploratory laparotomy?

Thank you!
Abdominal gunshot wound--
Unstable pt----> Exp. Lap with or without FAST.
Stable pt---> CT Scan followed by Exp Lap

Penetrating Injury---> Unstable pt -----> FAST followed by Exp lap

Stable pt----> FAST scan>>>>if equivocal CT scan>>>DPL as the patient may not need Exp lap if the peritoneum is not breached or of breached may be a candidate for close observation.
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Old 05-25-2012
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Quote:
Originally Posted by Novobiocin View Post
Abdominal gunshot wound--
Unstable pt----> Exp. Lap with or without FAST.
Stable pt---> CT Scan followed by Exp Lap

Penetrating Injury---> Unstable pt -----> FAST followed by Exp lap

Stable pt----> FAST scan>>>>if equivocal CT scan>>>DPL as the patient may not need Exp lap if the peritoneum is not breached or of breached may be a candidate for close observation.
in case of penetrating abd injury, we should go directly with Exp lap, i dont think we should pick FAST as the next step in mgm
FAST would be the best step in the mgm of unstable blunt abd trauma
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Old 05-25-2012
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Quote:
Originally Posted by bisho View Post
in case of penetrating abd injury, we should go directly with Exp lap, i dont think we should pick FAST as the next step in mgm
FAST would be the best step in the mgm of unstable blunt abd trauma
I agree..............
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Old 05-26-2012
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Quote:
Originally Posted by bisho View Post
in case of penetrating abd injury, we should go directly with Exp lap, i dont think we should pick FAST as the next step in mgm
FAST would be the best step in the mgm of unstable blunt abd trauma

But if today the patient is stabbed with a short knife, do we still get exp. laparotomy? In this case shouldn't we do finger exploration first?

Thank you!
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Old 05-26-2012
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Quote:
Originally Posted by chienpolska View Post
But if today the patient is stabbed with a short knife, do we still get exp. laparotomy? In this case shouldn't we do finger exploration first?

Thank you!
as per kaplan surgery, do finger expln to know the extent. if it is deep [ close to peritoneum or peritoneum] expl lapro is ans.
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