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When ongoing abdominal hemorrhage is confirmed, hindlimb and abdominal binding see Hindlimb and Abdominal Binding is indicated early to reduce the amount of hemorrhage until hemostasis is accomplished. After injury of any abdominal organ, clinical signs of organ dysfunction or hollow viscus rupture typically develop over a period of hours but may be longer or shorter depending on the nature of the injury. Acute abdominal pain is a key physical finding. Survey abdominal radiographs can demonstrate organ displacement, distention, rotation, or free abdominal gas or fluid.

Fluid can be recovered by four-quadrant abdominocentesis. Using the focused assessment with sonography technique FAST, see Evaluation and Initial Treatment of the Emergency Patient:Hemostasis , even small amounts of free fluid in the abdomen can be identified and aspirated using ultrasound guidance. When free fluid is not readily identified, a diagnostic peritoneal lavage can be done.

Surgical Critical Care Year in Review - Wendy Greene MD, FACS, FCCM

The fluid is allowed to dwell for several minutes and distribute throughout the abdomen; it is then drained and evaluated. Clear fluid indicates that the possibility of significant abdominal hemorrhage is minimal.

Thoracic Trauma, Blunt, Pain Management of

Fluid obtained from the abdomen should be examined cytologically for evidence of WBCs, plant or meat fibers, and free or intracellular bacteria. Biochemical evaluation for creatinine and potassium, bilirubin, amylase, and phosphorus help identify urinary system rupture, gallbladder rupture, pancreatic injury, or ischemic bowel, respectively. The abdominocentesis, peritoneal lavage, or FAST scan can be repeated in several hours if fluid from the first assessment did not indicate a significant problem but the clinical signs continue or progress.

Retroperitoneal, fascial, or intramuscular body wall hemorrhage or hemorrhage into the GI system can be more challenging to identify. Criteria for emergency exploratory laparotomy include ongoing hemorrhage; inability to stabilize shock; organ rotation, entrapment, or ischemia; diaphragmatic hernia; and evidence of organ rupture or peritonitis.

Some simple bladder ruptures may be amenable to medical management and placement of a urinary catheter. Surgery to repair a diaphragmatic hernia should not be delayed, particularly with gastric displacement into the thoracic cavity, respiratory compromise, or ongoing hemorrhage. Radiographs typically show expansion and loss of detail in the retroperitoneal space.

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An IV pyelogram should be done to help delineate disruption in the renal vascular supply or in the retroperitoneal portion of the ureter before proceeding with exploratory surgery in this situation. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world.

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Overview of Thoracic Trauma - Injuries; Poisoning - MSD Manual Professional Edition

Case studies are included. Thoracic Trauma: The Deadly Thoracic Trauma: The Deadly Dozen. Share This. Log In required for purchase : User name is required Password is required. Inhalation Injuries. Gregory J. Bauer, Nicole Gibran, David M. Thoracic Missile Emboli and Retained Bullets. John B. Surgical Management of Airway Obstruction. Complications of Lung Transplantation. Air Embolism. Massive Hemoptysis. Cairen J. Tracheo-Innominate Artery Fistula.

Blaine Achen, Cairen J. McNamee, Tyler Black. PA Catheter Induced Hemoptysis. Re-expansion Pulmonary Edema. Postpneumonectomy Pulmonary Edema. The Sonographic Detection of Pneumothoraces. Front Matter Pages N4-N4. Pulmonary Contusion. Reconstruction of Complex Chest Wall Defects.

Bibliographic Information

Burns of the Chest Wall. Traumatic Lung Hernia. Diaphragmatic Injuries.