abscess advanced trauma life support anterio advanced trauma life support antibiotics apically repositioned flap dental diseases dr dr shabeel drshabeel’s face eye trauma lidocaine anodontia management medical medicine misuse and abuse orthodontics teeth braces pharmacy pn preparation dental students for community based ed presentations s abscess abscess tooth active orthodonti shabeel shabeel"s shabeel’s shabeelpn trends of antimicrobial usage in dental practice View all
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INITIAL ASSESSMENT OF TRAUMA PATIENTS....(INSPIRED FROM CTLS AND ATLS GUIDELI...Prerna Biswal
THIS PRESENTATION WAS MADE AT IMA HOUSE IN BHUBANESWAR,ODISHA, BY DR.NIBEDITA PANI,HOD ,DEPT. OF ANAESTHESIOLOGY AND DR.PRERNA BISWAL,PG,ANAESTHESIOLOGY,SCBMCH,CUTTACK,
abscess advanced trauma life support anterio advanced trauma life support antibiotics apically repositioned flap dental diseases dr dr shabeel drshabeel’s face eye trauma lidocaine anodontia management medical medicine misuse and abuse orthodontics teeth braces pharmacy pn preparation dental students for community based ed presentations s abscess abscess tooth active orthodonti shabeel shabeel"s shabeel’s shabeelpn trends of antimicrobial usage in dental practice View all
’s abscess abscess advanced trauma life support anterio abscess tooth active orthodontics adolescent advanced trauma life support aesthetic dentistry airway management alignment of teeth amalgam anesthesia in dentistry anesthetics in dentistry anterior open bite antibiotic resistanace antibiotics antibiotics and leukopenia aphthous ulcers apically repositioned flap apicoectomy appliances arch dental arch form orthodontics braces arch length orthodontics braces arch wire orthodontist braces ayurvedha baby teeth bloger boil books braces braces teeth cancer canker sore pain cavity preparation children community based learning congenitally missing teeth cosmetic dentistry csf leaks dental dental anesthetics dental restorations dental teeth dento alveolar fractures disease
INITIAL ASSESSMENT OF TRAUMA PATIENTS....(INSPIRED FROM CTLS AND ATLS GUIDELI...Prerna Biswal
THIS PRESENTATION WAS MADE AT IMA HOUSE IN BHUBANESWAR,ODISHA, BY DR.NIBEDITA PANI,HOD ,DEPT. OF ANAESTHESIOLOGY AND DR.PRERNA BISWAL,PG,ANAESTHESIOLOGY,SCBMCH,CUTTACK,
ATLS is two days course for those who manage trauma patients. These protocols have been followed by hospitals all over the world to treat trauma patients quickly and efficiently.
Content will be helpful for B.Sc. and M.Sc. nursing students as it describes causes, signs and symptoms, diagnosis,emergency mangement , medical and nursing management.
enteral nutrition, nutrition, nutrition after surgery, nutrition of debilitated patient, nutrition of patient who cant take orally, post operative care, surgical nutrition, total parentral nutrition
ATLS is two days course for those who manage trauma patients. These protocols have been followed by hospitals all over the world to treat trauma patients quickly and efficiently.
Content will be helpful for B.Sc. and M.Sc. nursing students as it describes causes, signs and symptoms, diagnosis,emergency mangement , medical and nursing management.
enteral nutrition, nutrition, nutrition after surgery, nutrition of debilitated patient, nutrition of patient who cant take orally, post operative care, surgical nutrition, total parentral nutrition
Polytrauma and multiple traumata are medical terms describing the condition of a person who has been subjected to multiple traumatic injuries. This will be more prevalent in our country
Successful management of Polytrauma must achieve the following goals, 1- Keep someone alive that would be dead without you 2- Prioritize treatment to prevent killing someone 3- Treat extremity injuries to return the patient to a functional life. The Priorities are 1- Life threatening, 2- Limb threatening, 3- Function threatening. The question about the best strategy in the management Polytrauma and the choice between an Early Total Care (ETC) vs. Damage Control Orthopedics (DCO) will be answered in this presentation.
1. Initial assessment and management of the trauma patient.pptxWalterBenites2
La primera etapa del curso ATLS (Advanced Trauma Life Support) se conoce como "Evaluación Inicial". En esta etapa, los estudiantes de medicina aprenden un enfoque sistemático y estructurado para evaluar a un paciente traumatizado de manera rápida y eficaz.
La Evaluación Inicial se centra en identificar y abordar de inmediato las lesiones que amenazan la vida del paciente.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
3. • Trauma/ injury = cellular disruption caused by
an exchange with environmental energy that
beyond body’s resilience
• = cell death due to ischemia or reperfusion
• Most common cause of death between age 1-
44 years
• Third most common cause of death regardless
of age
• Causes 110,000 deaths per year, 40% from
motor vehicle collisions
5. Preparation
• Prehospital phase:
– EMS
– Should be set up to notify the receiving hospital
before personnel transport from the scene
• Hospital phase: primary survey
6. • Emphasis on:
– Airway maintenance
– Control of external
bleeding and shock
– Immobilization
– Immediate transport to
the nearest hospital
7. Triage:
sorting the patients
based on their needs
for treatment and the
resource available to
provide that
treatment
http://www.cdc.gov/mmwr/previe
w/mmwrhtml/rr6101a1.htm.
CDC, January 13th, 2012
8. • Multiple Casualties:
– the number and severity of patients do not exceed
capability of the facility
– Patients with life-threatening conditions and
multiple system injuries are treated first
• Mass Casualties
– Exceed
– Patient with greatest chance of survival and
requiring expenditure of time, equipment, supplies,
and personnel, are treated first
9. Primary Survey
• ATLS: ABCDEs and adjuncts
• 10-second assessment: What’s your name?
What happen?
• Life-threatening injuries must be identified and
treated before distracted by secondary survey
10.
11. Airway Management with
Cervical Spine protection
• First Priority
• Conscious, normal voice without tachypnea
should be OK but repeat assessment is
essential
• Exceptions: penetrating neck injury, complex
maxillofacial trauma, inhalation injury
• Require further evaluation: abnormal voice or
breathing sound, tachypnea, altered mental
status
12. • Predicting difficult airway: LEMON
• Maintaining airway maneuvers: chin lift, jaw
thrust, pharyngeal airway, LMA etc
• Definitive airway: a tube placed in trachea with:
– Cuff inflated below vocal cord
– Connected to oxygen-enriched assisted ventilation
– Secured in place with tape
Airway Management with
Cervical Spine protection
16. Airway Management with
Cervical Spine protection
• Don’t forget c-spine!!!!
• Apply hard collar or sandbags to all patients
who are suspected c-spine injury, blunt trauma,
and altered mental status
• Soft collar shows no benefit
17. Breathing with Ventilation
• Life-threatening conditions: open, tension
pneumothorax, massive air leak, severe flail
chest
• Look for indication to ICD
18. Circulation with Hemorrhagic Control
• Palpable pulse:
– Carotid = 60 mmHg
– Femoral = 70 mmHg
– Radial = 80 mmHg
• Any episode of hypotension is assumed to be
caused by HEMORRHAGE until proven
otherwise
19. • IV access for fluid resuscitation:
– 2 peripheral catheter, 16 gauge or larger
– If difficult: IO (<6yrs), saphenous cutdown, femoral or
subclavian vein insertion
• 5 potential area: chest, abdomen, pelvis, long bone,
external
• External Control of visible hemorrhage:
– Simultaneous with fluid resuscitation
– Manual compression
– Avoid blind clamping
Circulation with Hemorrhagic Control
20. • Tourniquet can cause tissue necrosis but may
be essential to save life (in case of direct
pressure failure)
• Open fractures: reduction and immobilization
• Scalp laceration deep to galea: skin staples,
continuous suture to stop bleeding
Circulation with Hemorrhagic Control
21. • FAST
• Massive Hemothorax
– >1500ml from ICD
– > 25% of blood volume in children
– Usually from multiple rib fractures, occasionally
from lung laceration
– Suspected great vessels or pulmonary hilar vessels
injury
– Indication for operative intervention
Circulation with Hemorrhagic Control
22. • Cardiac tamponade
– Beck’s triad
– FAST
– most common cause: penetrating chest injury
– < 100 ml
– RV output
– Initial Treatment: fluid resuscitation and
pericardiocentesis (80% success)
– SBP< 60 mmHg: resuscitative thoracotomy
Circulation with Hemorrhagic Control
23. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 167
24. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 168
25. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 169
26. Shock
Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 171
27. Shock
• = inadequate tissue perfusion
• In trauma, always HEMORRHAGIC until
proven otherwise
• The goal of fluid resuscitation is to re-establish
tissue perfusion
• 2 L in adult, 20 ml/kg in child IV bolus,
usually warm Ringer’s lactate
29. Shock: Persistent Hypotension
• Either transient or nonresponders
• Consider categories of shock: hemorrhagic,
cardiogenic, neurogenic, septic
• FAST helps
• CVP may guide: > 15 cmH2O: cardiogenic, < 5
cmH2O: hypovolemic
• Other monitor: urine output, oxygen
saturation, base deficit, lactate
30. • DDx of cardiogenic shock in trauma:
– Tension pneumothorax (most common)
– Cardiac tamponade
– Blunt cardiac injury
– Bronchovenous air embolism
• In blunt cardiac injury:
– EKG and TropT help
– ECHO is performed
– Most common finding is RV dyskinesia due to
orientation
– AMI may be the cause of accidents in older patients
Shock: Persistent Hypotension
31. • Air embolism
– Air from injured bronchus entered injured
pulmonary vein and returns air to left heart,
resulting in impeded diastolic filling
– And during systole, air is pumped into coronary
arteries
– Treatment: Trendelenburg position and emergency
thoracotomy to cross-clamping to prevent further
embolism, air aspiration, and controlling the injury
Shock: Persistent Hypotension
32. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 172
33. Shock
• If persistent hypotension with negative FAST and
no obvious source DPL
• Hypotensive resuscitation, permissive
hypotension, balanced resuscitation, controlled
resuscitation: keep BP 90/60 mmHg
• Fracture-related blood loss:
– Each rib fracture: 100-200 ml
– Tibia: 300-500 ml
– Femur: 800-1,000 ml
– Pelvic: > 2000 ml
37. Special Diagnostic Tests
• Head: CT brain (non-contrast), facial bone
reconstruction, c-spine
Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 175
38. • Neck:
– In blunt injury: cervical spine injury has to be
ruled out
– Observe expanding hematoma, airway obstruction,
aerodigestive injuries
Special Diagnostic Tests
40. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 176
41. • Chest:
– Most injuries can be evaluated by PE and CXR
– CXR is needed after ETT, ICD, central line
insertion
– Persistent pneumothorax should undergo fiberoptic
bronchoscopy to exclude tracheobronchial injury
– CXR after ICD is required to document complete
evacuation; if persistent thoracotomy
Special Diagnostic Tests
42. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 178
43. • Abdomen:
– Blunt or penetrating
– If penetrating: stab wound or GSW
– FAST will be positive when free fluid > 250 ml
– Anterior abdominal SW: explore under LA to
determine if fascia is injured
– For GSW: >90% have internal abdominal injuries
Special Diagnostic Tests
44. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 180
45. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 181
46. • Pelvis:
– Foley catheter in one attempt
– Film pelvis AP
– CT pelvis to evaluate precise geometry
– CT cystograms
– Urethrograms
– CT angiogram
Special Diagnostic Tests
47. • Extremities:
– Film
– Vascular injuries: hard and soft signs
– Doppler u/s
– CT angiogram
Special Diagnostic Tests
51. Damage Control Surgery
• The purpose is to limit operative time and
return patient to ICU from physiologic
restoration
• The goal is to control surgical bleeding and
limit GI contamination and definitive repair of
injuries delayed until patient is physiologically
replete
52. • bloody vicious cycle (lethal triad)
• Hypothermia, coagulopathy, metabolic
acidosis
• Indications to institute DCS technique
– BT < 35oC
– Profound acidosis ABG pH < 7.2, base deficit >
15 mmol/l
– Refractory coagulopathy
Damage Control Surgery
53. • Arterial injuries:
– Ligation tolerable: Rt/Lt hepatic, celiac
• Venous injuries: ligation except suprarenal
IVC and popliteal
• Solid organ injuries:
– Spleen/kidney: Excision > repair
– Hepatic injuries: packing, foley cath ballooning for
GSW
Damage Control Surgery
54. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 189
55. • Lung injuries: open parenchymal tract by TA
stapler, access to injured vessels and bronchi,
and ligate by PDS 3-0, and the tract left
opened
• Cardiac injuries: temporarily controlled with
3-0 polypropylene, running
Damage Control Surgery
56. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 195
57. • GI contamination:
– Small injuries: repair using 2-0 polypropylene
– Complete transection: GIA stapler to resect
damage segment and open end may be ligated by
umbilical tape
• Pancreatic injuries: pack and evaluate duct
later
• Urologic injuries: catheter diversion
Damage Control Surgery
58. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 196
63. Head Injuries
• Maxillofacial:
– Most common scenario which can be life-
threatening: bleeding from facial fracture
– Don’t forget to protect the airway!
– Contraindication of NG
– Fractures of tooth-bearing bone = open fractures
64. American College of Surgeons ACS Committee of Trauma. ATLS Student Course Manual. 8th ed. Chicago:
American College of Surgeons, 2008. page 59
65. Cervical Injuries
• Spine:
– At ER: Immobilization and CT C-spine
– Treatment based on:
• Level
• Stability
• Presence of subluxation
• Extent of angulation
• Level of neurologic deficit
– Treatment:
• axial traction via cerival tong > halo vest
67. • Spine:
– Treatment:
• Surgical fusion in pt with neurodeficit or remain
unstable after halo placement
• Methylprednisolone (30 mg/kg IV bolus, then 5.4mg/kg
in 23 hr)
• Urgent surgical decompression: may be done in patients
with incomplete tetraplegia or neurologic deterioration
Cervical Injuries
68. • Vascular:
– Penetrating injuries: neck exploration to repair
– All carotid injuries should be repaired except in
patients who present in coma with a delay in
transport
– Blunt injuries:
• May cause dissection, thrombosis, pseudoaneurysm
• Patients treated with antithrombotic agent have a stroke
rate < 1% compared with 20% in untreated patients
Cervical Injuries
69. Brunicardi FC et al. Schwartz’s
Principles of Surgery. 10th ed.
McGraw-Hill Education, 2015.
page 199
70. Cervical Injuries
• Aerodigestive
– sign: subcutaneous emphysema
– CT usually repaired
– Common: thyroid cartilage fractures, thyroepiglottic
ligament rupture, vocal cord tears,cricoid fractures
– Tracheal injuries: debridement and end-to-end repair
with single layer, interrupted, absorbable suture
– Esophageal rupture: debridement, repair, and
interposition of SCM or strap muscles to prevent
fistulas
71. Chest Injuries
• Most common injuries are hemothorax and
pneumothorax
• 85% can be definitively treated with ICD
• Even initial chest tube output is 1.5L, if the
output ceases, lung re-expanded, and
hemodynamically stable, it can be
nonoperatively managed
75. Chest Injuries
• Great vessels:
– >90% are penetrating
– Blunt injuries to innominate, subclavian, or
descending aorta may cause pseudoaneurysm or
frank rupture
– Simple laceration of aortic arch: lateral aortorrhapy
– To prevent aortic rupture: esmolol, keep SBP <
100 mmHg, HR < 100/min
76. Chest Injuries
• Heart
– Before repair, bleeding should be controlled
– Temporary control: skin staples for LV laceration
– Definitive repair: running 3-0 polypropylene, or
interrupted pledgeted 2-0 polypropylene suture in
RV to prevent sutures from pulling through the
thinner myocardium
– ECHO may be done
– No pathognomonic signs on EKG and TropT
doesn’t tell risk of complications
77. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 201
78. Chest Injuries
• Trachea, Bronchi, and Lung Parenchyma:
– ICD: pneumothorax
– Same as injuries at neck
– Bronchial injuries less than 1/3 circumference of
airway and no persistent air leak can be expectantly
managed
– Bronchoscope with direct fibrin glue may be useful
– Most complication after injury: empyema
• PCD
• Decortication with VATS
• Antibiotics (cover MRSA in ICU)
79. Chest Injuries
• Esophagus
– Often occurs with tracheobronchial injuries, in
penetrating trauma
– Same as injuries at neck +- gastrostomy
80. • Chest wall and diaphragm
– Rib fractures: pain control + ventilation support
– Diaphragmatic injury:
• Blunt: large radial tear
• Penetrating: variable size
• Develop diaphragmatic hernia
• Treatment: direct repair by running 1 prolene or mesh
Chest Injuries
83. • Liver and extrahepatic biliary tract
– In liver injury without peritonitis or unstable
hemodynamic, nonoperative management with
serial examination in ICU is OK
– Angiogram and angioembolization: indication
• PRC > 4U in 6hr
• PRC > 6U in 24 hr
• Hemodynamic stable
– Indication for surgery is hemodynamic instability
Abdominal Injuries
84. • Liver and biliary tract
– Surgery:
• Initial control of hemorrhage is best by perihepatic
packing and manual compression and remove packing
at 24 hr
• Pringle maneuver: clamping across portal triad
bleeding should be stopped if injuries are at hepatic
artery or portal vein bleeding from hepatic vein and
retroperitoneum IVC will continue
• Gastroduodenal a. injury: ligation
• Proper hepatic a. should be repaired
Abdominal Injuries
87. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 183
88. • Spleen
– Extravasation risks for nonoperative management
failure
– Angioembolization
– Surgery:
• Splenectomy: hilar inj, grade II, completely destroyed
• Partial splenectomy: pole
• Splenorrhaphy with pledgated suture: cut edge
Abdominal Injuries
89. • Stomach and Small Bowel
– Single layer suture
Abdominal Injuries
90. • Duodenum and Pancreas
– Suture if perforation
– Duodenal hematoma observe
– Pancreas: determine parenchymal and damage
– Proximal (Rt to SMA) pancreatic injuries: closed
suction drainage
– Distal injuries: distal pancreatectomy
– CBD injury: Roux-en-Y choledochojejunostomy
Abdominal Injuries
91. • Colon and Rectum
– Treatment: primary repair, end colostomy, and
primary repair with diverting ileostomy
– All suturing and anastomoses are performed using
a running single-layer technique
– Complications: IAA, fecal fistula, wound
infection, stomal complications (necrosis, stenosis,
obstruction, prolapse)
Abdominal Injuries
92. • Genitourinary Tract
– Explore all penetrating wounds to kidneys when
undergoing laparotomy and treat same as liver and
spleen
– >90% of blunt renal injuries are treated
nonoperatively
– Hematuria will resolve in 2-3 days, but persistent
gross hematuria may require embolization
Abdominal Injuries
93. • Genitourinary Tract
– Bladder injuries: intraperitoneal suture, extra
bladder decompression for 2 wks
– Urethral inj: bridging the defect with foley
– Pelvic fracture penetrating to vagina = open
fracture
Abdominal Injuries
94. Pelvic Fracture Hemorrhage Control
• 85% of bleeding is from venous or bony in
origin
• Pelvic packing: 6-8 cm midline incision and
packing each side of bladder and preperitoneal
space
• Open pelvic fracture:
– High risk for pelvic sepsis and osteomyelitis
– Recommendation: divesting sigmoid colostomy
and debridement
95. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015. page 213
97. Brunicardi FC et al. Schwartz’s Principles of
Surgery. 10th ed. McGraw-Hill Education,
2015. page 220
98. Brunicardi FC et al. Schwartz’s Principles of
Surgery. 10th ed. McGraw-Hill Education,
2015. page 220
99. References
Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed.
McGraw-Hill Education, 2015.
American College of Surgeons ACS Committee of Trauma. ATLS
Student Course Manual. 9th ed. Chicago: American College of
Surgeons, 2012.
Mattox KL et al. Trauma. 7th ed. McGraw-Hill Medical, 2013.
Kaiser LR et al. Mastery of Cardiothoracic Surgery. 3rd ed.
Philadelphia: Lippincott Wiliams & Wilkins, 2014.