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Old 08-22-2012
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Default stable patient with penetrating abdominal injury

Hi all:

as titled, for stable patients, shall we do CT and observe or we go straight to FAST followd by exploratory laparatomy?
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Old 08-22-2012
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Ex-lap indications:
1. Stab or gun shot wound to abdomen
2. Acute abdomen/Peritonitis (rebound tenderness, gaurding)
3. Hemodynamic instability in a penetrating trauma

Blunt abdominal trauma
If patient is stable: CT performed first
If patient is unstable (hemodynamically): FAST performed, if not diagnostic, followed by peritoneal lavage. If either are positive, Ex-lap performed
If patient is unstable with signs of peritonitis: Ex-lap

Hope this helps
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Old 08-22-2012
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Quote:
Originally Posted by mis.med88 View Post
Ex-lap indications:
1. Stab or gun shot wound to abdomen
2. Acute abdomen/Peritonitis (rebound tenderness, gaurding)
3. Hemodynamic instability in a penetrating trauma

Blunt abdominal trauma
If patient is stable: CT performed first
If patient is unstable (hemodynamically): FAST performed, if not diagnostic, followed by peritoneal lavage. If either are positive, Ex-lap performed
If patient is unstable with signs of peritonitis: Ex-lap

Hope this helps

for blunt abdominal injury, if patient is unstable, we should do FAST first followed by CT is FAST is unequivocal and followed by DPL if CT is uneuivocal.

Please correct me if i am wrong.
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Old 08-22-2012
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Emedicine (Blunt abdominal trauma work-up under CT imaging):

Transport only hemodynamically stable patients to the CT scanner. When performing CT scans, closely and carefully monitor vital signs for clinical evidence of decompensation. Preliminary evidence suggests that a flat vena cava on CT scan is a marker for underresuscitation and may be correlated with higher mortality and hemodynamic decompensation.[26]
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