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GPC # 1.4:
PACIENTE CON
TRAUMA DE
ABDOMEN
Julián Rondón Carvajal
Médico S.S.O.
Hospital Germán Vélez Gutiérrez
Betulia - A...
CONTENIDO

1.
2.
3.
4.
5.

GENERALIDADES
ANATOMÍA
DIAGNÓSTICO Y MANEJO
IMÁGENES EN URGENCIAS
BIBLIOGRAFÍA
1. GENERALIDADES



Accidentes de tránsito: incremento de casos
Colombia: 30.000 muertes/año
32% con compromiso abdomina...
2. ANATOMÍA
-

Cavidad peritoneal: Superior e inferior

Colon ascendente, descendente, sigmoides
Intestino delgado

__________________...
3. DIAGNÓSTICO Y MANEJO
3.1 TRAUMA CERRADO
Compresión, desaceleración o aplastamiento
 Frecuencia de órganos lesionados:
...


Siempre evaluar pelvis y periné

Lab: HLG + hemoclasificación
GASA, uroanálisis (40% trauma renal es normal)



ECO-FA...
3.2 TRAUMA ABIERTO


Tipos de heridas: PAF vs ACP



Sospecha de herida abdominal:
5 EIC – LAA
6 EIC – LAM
7 EIC – LAP

...


HACP: Siempre palpación digital (> 0.5 cm)
VO a las 12 h + Observación por 24-48 h
TAC abdominal
Laparoscopia diagnósti...
4. IMÁGENES EN URGENCIAS

¿?
¿?
¿?
¿?
5. BIBLIOGRAFÍA
Basado en:




Guías para Manejo de Urgencias. Tercera
Edición. TOMO I: Grupo Atención de
Emergencias y ...
Gpc no. 1.4 trauma de abdomen
Gpc no. 1.4 trauma de abdomen
Gpc no. 1.4 trauma de abdomen
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Gpc no. 1.4 trauma de abdomen

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Guía de manejo del paciente con trauma de abdomen en bajo nivel de complejidad

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Gpc no. 1.4 trauma de abdomen

  1. 1. GPC # 1.4: PACIENTE CON TRAUMA DE ABDOMEN Julián Rondón Carvajal Médico S.S.O. Hospital Germán Vélez Gutiérrez Betulia - Antioquia
  2. 2. CONTENIDO 1. 2. 3. 4. 5. GENERALIDADES ANATOMÍA DIAGNÓSTICO Y MANEJO IMÁGENES EN URGENCIAS BIBLIOGRAFÍA
  3. 3. 1. GENERALIDADES   Accidentes de tránsito: incremento de casos Colombia: 30.000 muertes/año 32% con compromiso abdominal 50% LE  Revisión primaria vs secundaria  Dos conceptos novedosos: - Manejo conservador - Control de daño
  4. 4. 2. ANATOMÍA
  5. 5. - Cavidad peritoneal: Superior e inferior Colon ascendente, descendente, sigmoides Intestino delgado __________________________ - Área retroperitoneal Aorta abdominal, VCI, páncreas Duodeno, parte de colon ascendente y descendente Riñones, ureteres, órganos retroperitoneales ___________________________ - Pelvis Recto, vejiga, vasos ilíacos Útero, ovarios y resto de anexos
  6. 6. 3. DIAGNÓSTICO Y MANEJO 3.1 TRAUMA CERRADO Compresión, desaceleración o aplastamiento  Frecuencia de órganos lesionados: Bazo (30-60%) Hígado (40-50%) Riñón (15-20%) EF: S 50-60%  I= Marcas en piel P= Timpanismo, matidez A= Peristaltismo ausente Pa= Irritación peritoneal
  7. 7.  Siempre evaluar pelvis y periné Lab: HLG + hemoclasificación GASA, uroanálisis (40% trauma renal es normal)  ECO-FAST (Focused Abdominal Sonogram for Trauma)
  8. 8. 3.2 TRAUMA ABIERTO  Tipos de heridas: PAF vs ACP  Sospecha de herida abdominal: 5 EIC – LAA 6 EIC – LAM 7 EIC – LAP  Frecuencia de órganos lesionados: Intestino delgado (40-50%) Hígado (30%)
  9. 9.  HACP: Siempre palpación digital (> 0.5 cm) VO a las 12 h + Observación por 24-48 h TAC abdominal Laparoscopia diagnóstica  Conducta frente a epliplocele  Laparotomía exploratoria Inestabilidad hemodinámica Irritación peritoneal ¿HPAF penetrante en abdomen? HACP con evisceración
  10. 10. 4. IMÁGENES EN URGENCIAS ¿?
  11. 11. ¿?
  12. 12. ¿?
  13. 13. ¿?
  14. 14. 5. BIBLIOGRAFÍA Basado en:   Guías para Manejo de Urgencias. Tercera Edición. TOMO I: Grupo Atención de Emergencias y Desastres. Convenio FEDERACIÓN PANAMERICANA DE ASOCIACIONES DE FACULTADES [ESCUELAS] DE MEDICINA FEPAFEM 2009. Ministerio de Protección Social. República de Colombia. http://zl.elsevier.es/es/revista/radiologia-119/articulo/manejo

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