Abdominal Trauma

Step 1: Does This Patient Need Surgery NOW? * Obvious penetrating injury to abdomen* Peritonitis* Hypotensive Step 2: FAST Scan * Performed with bedside ultrasound machine* Blood/intra-peritoneal fluid is hypoechoic (black) in appearance* Four views required* Right upper quadrant* Probe marker points towards patient’s head* “Morrisons Pouch”* Potential space between liver and right kidney* Left upper quadrant* Probe marker towards patient’s head* Most difficult view to obtain* Potential space around spleen and between spleen and left kidney* Suprapubic* Probe marker towards patient’s head* Looking for thin rim of fluid between bladder wall and bowel wall* Subxiphoid* Hold probe flat and aim through liver towards heart* Looking for fluid around heart and evidence of cardiac tamponade Step 3: Consider the Mechanism * Low risk* Low speed MVAs* Falling down only a few steps* High risk* Falling off ladder/roof* High velocity MVA/impact Step 4: Perform Careful Abdominal Exam * Pain* Bruising/Seatbelt sign* Distension* Peritonitis* Rigidity* Rebound* Guarding Step 5: Obtain Imaging if High Risk Mechanism or Abnormal Exam * CT Abdomen/Pelvis with IV contrast* If normal CT scan but you still have clinical concern- ADMIT* Serial abdominal exams* CT notorious for missing small bowel and diaphragmatic injuries Additional Reading * Trauma Basics (EM Clerkship)* FAST Examination (SAEM)