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Blunt abdominal trauma

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This document summarizes blunt abdominal trauma in children. It covers common causes including motor vehicle crashes and falls. Mortality varies from less than 20% for isolated injuries to 50% for major vessel injuries. The anatomy of children's abdomens makes them more susceptible to injury. Evaluation involves history, physical exam assessing signs of injury, and diagnostic testing including lab work, ultrasound, CT scans, and possible laparotomy. Common injuries discussed are spleen lacerations, liver lacerations, bowel perforations, and injuries from seat belts. Guidelines are provided for treatment and length of stay based on injury grade.

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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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