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Blunt abdominal trauma

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Blunt Abdominal Trauma Jose David Gamez, MD.
Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mortality ,[object Object],[object Object],[object Object],Cantor RM, Leamin JM. Evaluation and management of pediatric major trauma. Emer Med Clin Noth Am 1998.
Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Evaluation ,[object Object],[object Object],[object Object],Moos RL, Musemeche CA. Clinical judgment is superior to diagnostic test in the management of pediatric small bowel injury. J pediatr Surg 1996.
Mechanism of injury ,[object Object],[object Object],[object Object]
Physical Exam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Abdomen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Associated injuries ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Laboratory Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],Taylor GA et al. Hematuria. A marker of abdominal injury in children after blunt trauma. Ann Surg 1988
Laboratory Evaluation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Holmes et al. Identification of children with intra-abdominal injuries after blunt trauma. Ann Emerg Med. 2002.
Radiologic Evaluation ,[object Object],[object Object],[object Object],[object Object]
Radiologic Evaluation: CT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Indications CT scan ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Rothrock et al. Abdominal trauma in infants and children: prompt identification and early management of serious and life-threatening injuries. Pediatr Emerg Care 2000.
Radiologic Evaluation: US ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Peritoneal lavage ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Peritoneal lavage ,[object Object],[object Object],[object Object],[object Object],[object Object]
Spleen ,[object Object],[object Object],[object Object],[object Object],[object Object]
Spleen ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Splenic laceration classification GRADE TYPE FINDINGS I Hematoma Subcapsular, < 10% surface area Laceration Capsular tear, < 1cm parenchymal depth II Hematoma Subcapsular, 10-50% surface area; intraparenchymal, <5cm in diameter Laceration 1-3cm parenchymal depth; trabecular vessels not involved III Hematoma Subcapsular, >50% surface area or expanding; ruptured subcapsular or parenchymal hematoma; intraparenchymal hematoma >5 cm or expanding Laceration >3cm parenchymal depth or involving trabecular vessels IV Laceration Involves segmental or hilar vessels producing major devascularization (>25% of spleen) V Laceration Completely shattered spleen Vascular Hilar vascular injury that devascularizes spleen Moore et al. Organ injury scaling: spleen and liver. J Trauma 1995
Grade I Hematoma Subcapsular, < 10% surface area Laceration Capsular tear, < 1cm parenchymal depth
Grade II Hematoma Subcapsular, 10-50% surface area; intraparenchymal, <5cm in diameter Laceration 1-3cm parenchymal depth; trabecular vessels not involved
Grade III Hematoma Subcapsular, >50% surface area or expanding; ruptured subcapsular or parenchymal hematoma; intraparenchymal hematoma >5 cm or expanding Laceration >3cm parenchymal depth or involving trabecular vessels
Grade IV Laceration Involves segmental or hilar vessels producing major devascularization (>25% of spleen)
Grade V Laceration Completely shattered spleen Vascular Hilar vascular injury that devascularizes spleen
Guidelines ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury. The APSA Trauma Commite. J Pediatr Surg. 2000
Guidelines ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Liver ,[object Object],[object Object],[object Object],[object Object],[object Object]
Hemobilia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pancreas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pancreas ,[object Object],[object Object],[object Object],[object Object],[object Object]
GI tract ,[object Object],[object Object],[object Object],[object Object],[object Object]
Perforation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Duodenal Hematoma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Seat belt syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Laparotomy ,[object Object],[object Object],[object Object],[object Object]

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Blunt abdominal trauma

  • 1. Blunt Abdominal Trauma Jose David Gamez, MD.
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  • 20. Splenic laceration classification GRADE TYPE FINDINGS I Hematoma Subcapsular, < 10% surface area Laceration Capsular tear, < 1cm parenchymal depth II Hematoma Subcapsular, 10-50% surface area; intraparenchymal, <5cm in diameter Laceration 1-3cm parenchymal depth; trabecular vessels not involved III Hematoma Subcapsular, >50% surface area or expanding; ruptured subcapsular or parenchymal hematoma; intraparenchymal hematoma >5 cm or expanding Laceration >3cm parenchymal depth or involving trabecular vessels IV Laceration Involves segmental or hilar vessels producing major devascularization (>25% of spleen) V Laceration Completely shattered spleen Vascular Hilar vascular injury that devascularizes spleen Moore et al. Organ injury scaling: spleen and liver. J Trauma 1995
  • 21. Grade I Hematoma Subcapsular, < 10% surface area Laceration Capsular tear, < 1cm parenchymal depth
  • 22. Grade II Hematoma Subcapsular, 10-50% surface area; intraparenchymal, <5cm in diameter Laceration 1-3cm parenchymal depth; trabecular vessels not involved
  • 23. Grade III Hematoma Subcapsular, >50% surface area or expanding; ruptured subcapsular or parenchymal hematoma; intraparenchymal hematoma >5 cm or expanding Laceration >3cm parenchymal depth or involving trabecular vessels
  • 24. Grade IV Laceration Involves segmental or hilar vessels producing major devascularization (>25% of spleen)
  • 25. Grade V Laceration Completely shattered spleen Vascular Hilar vascular injury that devascularizes spleen
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