Blunt Injury to abdomen

Blunt Injury to abdomen

Q. 1

Blunt injury abdomen, patient was hemodynamically stable, next investigation:

 A

X-ray abdomen

 B

CT Scan

 C

FAST

 D

DPL

Q. 1

Blunt injury abdomen, patient was hemodynamically stable, next investigation:

 A

X-ray abdomen

 B

CT Scan

 C

FAST

 D

DPL

Ans. B

Explanation:

Ans:B. CT Scan.

Blunt Abdominal Trauma

  • The main first-line investigations are ultrasound, diagnostic peritoneal lavage, and computed tomography.

1. Plain abdominal radiography has no role in the assessment of blunt abdominal trauma.

2. Diagnostic Peritoneal Lavage(DPL): The presence of >100 000 red blood cells/mm3 indicates a clinically relevant haemoperitoneum, whereas the presence of >500 white blood cells/mm3 or vegetable matter signifies a hollow viscus injury. The presence of any of these parameters is regarded as an indication for laparotomy.

3. Ultrasound -It is a very useful, simpler, noninvasive method of evaluating the abdomen. Ultrasound has therefore replaced diagnostic peritoneal lavage as the investigation of choice in hemodynamically unstable patients.

4. Focused abdominal sonography for trauma (FAST)-  It is a rapid, noninvasive, portable bedside method of investigation focusing on the pericardium, splenic, hepatic and pelvic areas.

5. Computed tomography is the imaging modality of choice for evaluating hemodynamically stable patients.

  • It is the most commonly used and better investigation for abdominal trauma. It is useful in blunt/penetrating trauma, suspected pancreas, spleen, liver, duodenal, retroperitoneal injuries.
  • Smaller injuries, early haemoperitoneum are better detected.
  • It is noninvasive, highly specific, highly accurate (96%), with low false-positive/low false-negative, noninvasive.

 


Q. 2

A man with blunt injury abdomen after road side accident has a blood pressure of 100/80 mm Hg and a pulse rate of 120 bpm. Airway has been established and respiration has been stabilized. Next best step in management is?

 A

Immediate Blood Transfusion

 B

Blood for cross matching & IV fluid adminisration

 C

Ventilate the patient

 D

Exploratory laparotomy

Ans. B

Explanation:

  • Man in the question came with abdominal trauma with airway and breathing stabilized, is showing features of hypovolemia.
  • According to the ACLS protocol, he should receive intravenous fluids and blood should be taken for cross-matching to maintain the circulation intact.
  • IV access for fluid resuscitation should be obtained with two 16G peripheral catheters.
  • Blood should be drawn simultaneously and sent for measurement of hematocrit level, as well as for typing and cross-matching for possible blood transfusion in patients with evidence of hypovolemia. 

Q. 3

In Renal injury following blunt injury to abdomen which is not done –

 A

Prophylactic nephrectomy

 B

Diagnostic peritoneal lavage

 C

IVP

 D

Exploratory laparotomy

Ans. A

Explanation:

Ans. is ‘a’ i.e., Prophylactic nephrectomy 

Surgical exploration is indicated if there are signs of progresive blood loss or there is pulsatile or expanding perirenal hematoma.


Q. 4

Preferred incision for abdominal exploration in Blunt injury abdomen is :

 A

Always Midline incision

 B

Depending upon the organ

 C

Transverse incision

 D

Paramedian

Ans. A

Explanation:

Ans. is ‘a’ i.e. Always midline incision 

All emergency abdominal explorations in adults are performed using a long midline incision because of its versatility. For children under the age of 6, a transverse incision may be advantageous.


Q. 5

A man with blunt injury abdomen after road side accident has a blood pressure of 100/80 mm Hg and a pulse rate of 120 bpm. Airway has been established and respiration has been stabilized. Next best step in management is.

 A

Immediate Blood Transfusion

 B

Blood for cross matching & IV fluids

 C

Ventilate the patient

 D

Rush the patient to the OT

Ans. B

Explanation:

Ans is b i.e. Blood for cross matching & IV fluids 

Recall the ABC i.e. Airway, Breathing & Circulation.

  • Airway management- Ensuring an adequate airway is the first priority in the primary survey. This is essential since efforts to restore cardiovascular integrity will be futile unless the oxygen content of the blood is adequate
  • Breathing- Once a secure airway is obtained; adequate oxygenation and ventilation must be assured.
  • Circulation- With a secure airway and adequate ventilation established, circulatory status is addressed next. The primary goal is identification and control of hemorrhage. External hemorrhage is controlled by direct pressure on the wound while the possibility of hemorrhage into the chest, abdomen, or pelvis is rapidly assessed.

While steps are being taken to control hemorrhage, at least two large-bore IV lines should be inserted to allow fluid resuscitation. Blood should be drawn simultaneously and sent for typing and hematocrit.

Fluid resuscitation begins with a 1000-mL bolus of lactated Ringer’s solution for an adult and 20 mUkg for a child. Response to therapy is monitored by clinical indicators, including blood pressure, skin perfusion, urinary output, and mental status. If there is no response or only a transient response to the initial bolus, a second bolus should be given. If ongoing resuscitation is required after two boluses, it is likely that transfusion will be required and should be initiated early.

Here in this patient the Airway and Breathing are normal. He is having tachycardia, which is the earliest sign of blood loss. Thus circulation needs to be managed next.


Q. 6

Blunt injury abdomen, patient was hemodynamically stable, next investigation:

 A

X-ray abdomen

 B

Barium swallow

 C

FAST

 D

DPL

Ans. C

Explanation:

Ans is ‘c’ i.e. FAST 



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