ABDOMINAL

AND PELVIC
TRAUMA

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 AB DOMINAL AND PELVIC T RAUMA

Today's Discussion ABDOMINAL

Anatomy of The Abdomen and Pelvic
AND PELVIC
Mechanism of Injury TRAUMA
Diagnosis of Abdominal and Pelvic Trauma

Physical Examination

Primary Survey

Treatment

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ATLS 10th
Edition
 ANATOMY OF ABDOMEN

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 AB DOMINAL A ND PELVIC TR AUMA

Retroperitoneal Space
• Abdominal aorta / IVC
• Duodenum/ Pancreas
• Kidneys / Ureters
• Ascending/ Descending colon
• Retroperitoneal component of
the pelvic

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 ANATOMY OF PELVIC

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 AB DOMINAL AND PELVIC T RAUMA

Blunt
A. Direct Blow
Mechanisme of
B. Shearing Injuries
C. Deceleration injuries injury
Penetrating • Early identification of potential injuries
• Direct which diagnostic studies may be
necessary for evaluation
• identifies the potential need for patient
transfer

Blast

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 AB DOMINAL AND PELVIC T RAUMA

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 AB DOMINAL AND PELVIC T RAUMA

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 AB DOMINAL AND PELVIC T RAUMA

Blunt
Mechanisme of
injury
Penetrating • Early identification of potential injuries
• Direct which diagnostic studies may be
A. Stab Wounds (Low Energy) necessary for evaluation
B. High Energy gunshot
• identifies the potential need for patient
C.
transfer

Blast

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 AB DOMINAL AND PELVIC T RAUMA

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 AB DOMINAL AND PELVIC T RAUMA

Blunt
Mechanisme of
injury
Penetrating • Early identification of potential injuries
• Direct which diagnostic studies may be
necessary for evaluation
• identifies the potential need for patient
transfer

Blast

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 AB DOMINAL AND PELVIC T RAUMA

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 Physical
Examination

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 ABDOMINAL EXAMINATION

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 ABDOMINAL EXAMINATION

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 PELVIC EXAMINATION

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 URETHRAL / PERINEAL EXAMINATION

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 RECTAL EXAMINATION

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 VAGINAL EXAMINATION

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 AB DOMINAL AND PELVIC T RAUMA

Basic of Trauma Assessment

• Preparation
• Triage
• Primary Survey
⚬ Airway
⚬ Breathing
⚬ Circulation
⚬ Disability
⚬ Exposure and Control of the Environment
• Resuscitation
• Secondary Survey
⚬ Full History and Physical Exam to evaluate for other traumatic injuries
• Monitoring and Evaluation, Secondary adjuncts
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• Transfer to Definitive Care
⚬ ICU, Operating Theatre
 AB DOMINAL AND PELVIC T RAUMA

Primary Survey

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 AB DOMINAL AND PELVIC T RAUMA

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 AB DOMINAL AND PELVIC T RAUMA

FAST Exam
Focused Abdominal Sonography in
Trauma
4 views
• RUQ/Morrison's pouch
• Sub-xiphoid - view of heart
• LUQ (view of spleno-renal junction
• Bladder ( view of pelvis)

Liver and Kidney

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 AB DOMINAL AND PELVIC T RAUMA

FAST Exam
Focused Abdominal Sonography in
Trauma
4 views
• RUQ/Morrison's pouch
• Sub-xiphoid - view of heart
• LUQ (view of spleno-renal junction
• Bladder ( view of pelvis)

Pericardial Fluid, Liver

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 AB DOMINAL AND PELVIC T RAUMA

FAST Exam
Focused Abdominal Sonography in
Trauma
4 views
• RUQ/Morrison's pouch
• Sub-xiphoid - view of heart
• LUQ (view of spleno-renal junction
• Bladder ( view of pelvis)

fluid in the pouch of Douglas

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 AB DOMINAL AND PELVIC T RAUMA

FAST Exam
Focused Abdominal Sonography in
Trauma
4 views
• RUQ/Morrison's pouch
• Sub-xiphoid - view of heart
• LUQ (view of spleno-renal junction
• Bladder ( view of pelvis)

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 AB DOMINAL AND PELVIC T RAUMA

Pelvic Fracture and Associated Injuries

AP Compression Injury Lateral Compression Injury

• Associated with a motorcycle / head-on • Associated with a motorcycle / head-on

motor vehicle crash motor vehicle collision
• External rotation of the hemi pelvis • Internal rotation of the hemi pelvis
• Disrupted pelvic ring widens --> severe / • Reducing pelvic volume
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fatal hemorrhage • drive pubis into lower GU system
 AB DOMINAL AND PELVIC T RAUMA

Pelvic Fracture and Associated Injuries

Vertical Shear Injury
• Fall (>12 feet)
• High - energy shear force along vertical
plane across anterior and posterior
aspects of the ring
• Disrupt sacrispinous and sacrotuberous
ligament
• disrupt iliac vasculature --> severe
hemorrhage

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 AB DOMINAL AND PELVIC T RAUMA

Initial Management
• Rapid Hemorrhage control +
Fluid resuscitation
• Mechanical stabilization of the
pelvic ring and external
counter pressure

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 THANKYOU

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