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Un trauma abdominal intéressant

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Trauma abdominal intéressant

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  • DOWNLOAD THE BOOK INTO AVAILABLE FORMAT (New Update) ......................................................................................................................... ......................................................................................................................... Download Full PDF EBOOK here { https://urlzs.com/UABbn } ......................................................................................................................... Download Full EPUB Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... Download Full doc Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... Download PDF EBOOK here { https://urlzs.com/UABbn } ......................................................................................................................... Download EPUB Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... Download doc Ebook here { https://urlzs.com/UABbn } ......................................................................................................................... ......................................................................................................................... ................................................................................................................................... eBook is an electronic version of a traditional print book THE can be read by using a personal computer or by using an eBook reader. (An eBook reader can be a software application for use on a computer such as Microsoft's free Reader application, or a book-sized computer THE is used solely as a reading device such as Nuvomedia's Rocket eBook.) Users can purchase an eBook on diskette or CD, but the most popular method of getting an eBook is to purchase a downloadable file of the eBook (or other reading material) from a Web site (such as Barnes and Noble) to be read from the user's computer or reading device. Generally, an eBook can be downloaded in five minutes or less ......................................................................................................................... .............. Browse by Genre Available eBOOK .............................................................................................................................. Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, CookBOOK, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult, Crime, EBOOK, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, ......................................................................................................................... ......................................................................................................................... .....BEST SELLER FOR EBOOK RECOMMEND............................................................. ......................................................................................................................... Blowout: Corrupted Democracy, Rogue State Russia, and the Richest, Most Destructive Industry on Earth,-- The Ride of a Lifetime: Lessons Learned from 15 Years as CEO of the Walt Disney Company,-- Call Sign Chaos: Learning to Lead,-- StrengthsFinder 2.0,-- Stillness Is the Key,-- She Said: Breaking the Sexual Harassment Story THE Helped Ignite a Movement,-- Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones,-- Everything Is Figureoutable,-- What It Takes: Lessons in the Pursuit of Excellence,-- Rich Dad Poor Dad: What the Rich Teach Their Kids About Money THE the Poor and Middle Class Do Not!,-- The Total Money Makeover: Classic Edition: A Proven Plan for Financial Fitness,-- Shut Up and Listen!: Hard Business Truths THE Will Help You Succeed, ......................................................................................................................... .........................................................................................................................
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Un trauma abdominal intéressant

  1. 1. Du contraste inexplicable… Benoit Carrière MD 6 novembre 2014 CHU Ste-Justine - Service Médecine d’Urgence Pédiatrique
  2. 2. Début de nuit habituel… 15-20 patients pas encore vus en avant… 7-8 transferts de patients couchés, en attente d’hospit ou avec bilans en cours
  3. 3. …et comme ça peut nous arriver… Appel pris par collègue de soir - 23h00 Peu d’infos transmises une petite blessée attendue avec une douleur abdominale… Rappelez-vous vous-même?
  4. 4. Circonstances de l’accident fillette de 6 ans dormait dans l’auto passagère arrière d’une voiture allant à 100 km/h face à face vers 19h00
  5. 5. Sur la scène Encore attachée, trois points (?) Pas de perte de conscience, pas de convulsion Plainte spontanée de douleur abdominale Pas de plaie, pas de signes de fracture Pas de cervicalgie
  6. 6. Transportée P & C au centre hospitalier référant Approche ATLS Stable au niveau A-B Au niveau cardio-vasculaire: FC 120-150 TA normales-hautes 120-135/80-85
  7. 7. vomissements à 5-6 reprises, nausée Douleur abdominale importante, ballonnement ecchymose a/n quadrant inférieur
  8. 8. Transfert demandé Équipe inquiète de la douleur abdominale FAST négatif à 2 reprises Trauma rate? Seat belt injury?
  9. 9. Évaluation chez nous Urgence - 3h30 AM ABC stables neuro N Douleur et ballonnement abdo importants FAST +
  10. 10. Évaluation chez nous Urgence NPO Consult TRAUMA Écho abdo 5h15 Ascite important Doute sur perforation intestinale Aspect irrégulier de la vessie - perforation?
  11. 11. Évaluation chez nous Urgence PSA Air libre ++++ Contraste (?!?) a/n 2 reins Contraste entre les anses digestives
  12. 12. Passé à côté… Écho abdominale formelle effectuée au centre référant - 21h45 SCAN abdo-pelvien C+ fait au centre référant - 22h45 liquide libre perforation intestinale? pas de sonde urinraire en place, pas de contraste vessie
  13. 13. Salle d’op en fin de nuit Laparoscopie exploratoire Perforation vésicale réparée Aucune perforation digestive notée
  14. 14. Rupture vésicale
  15. 15. Rupture vésicale « plus la vessie est remplie, plus les risques d’une rupture sont importants »
  16. 16. Rupture vésicale Trauma contondant Trauma pénétrant Cause iatrogénique Rupture spontanée
  17. 17. TTrraauummaa ccoonnttoonnddaanntt TTrraauummaa pénétrant CCaauussee iatrogénique RRuuppttuurree spontanée AAcccciiddeenntt dd’’aauuttoo Décélération ppllaaiiee ppaarr bbaallllee CChhxx uurroollooggiiqquuee cchheezz ll’’aadduullttee 1100%% ddeess ffrraaccttuurreess dduu bbaassssiinn arme blanche CChhxx oobbssttééttrrccaallee AAllccoooolliiqquuee CCoouupp ddee ppooiinngg//ppiieedd sur vessie pleine ppeennsseerr àà bblleessssuurreess aassssoocciiééeess Chx orthopédique CChhxx aannttéérriieeuurree (trauma minime) BBaalllloonn ddee soccer/football CChhxx llaappaarroossccooppiiqquuee en pédiatrie
  18. 18. Rupture vésicale Extrapéritonéale Intrapéritonéale Combinée (extra & intrapéritonéale)
  19. 19. Rupture vésicale extrapéritonéale 90-100% de cas sont associées à des Fx bassin surtout de l’arche antérieur du pubis parfois par spicules osseux pas toujours même force déchirante entre fixité du bassin et inertie d’une vessie
  20. 20. Rupture vésicale extrapéritonéale Cystographie Extravasation de contraste à la base de la vessie espace périvésical aspect en flammes, en plumes, « starburst » vessie en forme de larme/teardrop Peut extravaser vers cuisse, périné, OGE, paroi abdo
  21. 21. Rupture vésicale intrapéritonéale Déchirure horizontale large dans le dôme vessie portion de la vessie moins « soutenue » seule portion de la vessie adjacente/couverte par péritoine plus grande proportion antan chez l’enfant
  22. 22. Rupture vésicale intrapéritonéale urine se déverse dans la cavité péritonéale délais possibles dans le diagnostic anomalies électrolytiques fausse anurie
  23. 23. Rupture vésicale intrapéritonéale Cystographie Extravasation dans la cavité péritonéale Contraste le long des anses dans les gouttières paracoliques sous le diaphragme
  24. 24. Rupture vésicale combinée (extra & intrapéritonéale) Cystographie Extravasation dans la cavité péritonéale Extravasation dans l’espace périvésical Habituellement avec trauma pénétrant
  25. 25. Présentation clinique Douleur abdominale suprapubienne Hématurie Incapacité d’uriner / Difficulté à uriner
  26. 26. Présentation clinique Douleur abdominale suprapubienne Distension abdominale Ressaut, défense, rebond Péristaltisme diminué, absent, iléus Vérifier prostate chez l’adolescent
  27. 27. Présentation clinique Hématurie Quasi-toujours présente (98%) Souvent macroscopique +/- 10% microscopique Si sang au méat, penser à lésion urétrale urétrographie rétrograde avant de cathétérisme à l’aveugle
  28. 28. Présentation clinique Incapacité d’uriner / Difficulté à uriner Pas chez tous les patients… Miction présente n’égale pas absence de rupture
  29. 29. Traitement conservateur pour RUPTURE EXTRAPÉRITONÉALE cathéter Foley pour 10-14 jours Cystographie de contrôle 85% seront guéries @ 7-10 jours presque toutes à 3 semaines
  30. 30. Traitement chirurgical pour RUPTURE INTRAPÉRITONÉALE très rares cas de Tx conservateur haut risque d’ascite urinaire, urémie, acidose Exploration et réparation, via sutures résorbables en continu Cathéter Foley aussi laissé en place qq jours • Cystographie de contrôle
  31. 31. • Cystographie de notre patiente • J#3 post-op

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