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ABC of major trauma. Abdominal trauma.

1990; BMJ; Volume: 301; Issue: 6744 Linguagem: Inglês

10.1136/bmj.301.6744.172

0959-8138

A Cope, W S L Stebbings,

Trauma Management and Diagnosis

The aim ofthis article is to enable all those concerned with the management of patients with abdominal trauma to perform a thorough examination and assessment with the help of diagnostic tests and to institute safe and correct treatment.Intra-abdominal injuries carry a high morbidity and mortality because they are often not detected or their severity is underestimated.This is particularly common in cases of blunt trauma, in which there may be few or no external signs.Always have a high index of suspicion ofabdominal injury when the history suggests severe trauma.Traditionally, abdominal trauma is classified as either blunt or penetrating, but the initial assessment and, if required, resuscitation are essentially the same. Blunt traumaRoad traffic accidents are one of the commonest causes of blunt injuries.Since wearing seat belts was made compulsory the number of fatal head injuries has declined, but a pattern of blunt abdominal trauma that is specific to seat belts has emerged.This often includes avulsion injuries of the mesentery of the small bowel.The symptoms and signs of blunt abdominal trauma can be subtle, and consequently diagnosis is difficult.A high degree of suspicion of underlying intra-abdominal injury must be adopted when dealing with blunt trauma.Blunt abdominal trauma is -usually associated with trauma to other areas, especially the head, chest, .. , :and pelvis. Penetrating traumaPenetrating wounds are either due to low velocity projectiles such as knives or hand gun bullets or high velocity projectiles such as rifle bullets and shrapnel from bombs or blasts.With the increasing prevalence of civilian violence penetrating injuries, especially those due to stabbing, are encountered increasingly in accident and emergency departments.Visceral injury occurs in 80-90% of bullet wounds but only 30% of stab wounds.Penetrating wounds may seem easy to diagnose, but it is difficult to assess whether peritoneal penetration has occurred.About a third of abdominal stab wounds with serious visceral injury at operation have virtually no physical signs.Stab wound. Assessment| Remember the A, B, C of the primary | Doctors must perform the primary survey-namely, airway management survey with protection of the cervical spine, breathing, and circulatory evaluation.The circulation may be compromised if there is concealed intra-abdominal bleeding.The usual diagnostic pathway of taking the history, physical examination, and special investigations cannot always be followed as To evaluate the abdomen Look, Feel, resuscitation is the highest priority.The sequence of look, feel, and listen and Listen will help in the rapid initial evaluation of the abdomen.