Transcript What is trauma
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What is TORSO : The body excluding the head and neck and limbs M.A.Kubtan
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The medical problems associated with physical injury .
Injury is the adverse effect of physical force upon a person .
Forces that can lead to injury include : mechanical , thermal ,ionizing radiation , and chemical .
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The Troso is generally regarded as the area between the neck and the groin ,made up of the thorax and abdomen .
Division of the body into abdomen and thorax is artificial .
Injury to the troso is more appropriate.
Our aim is restoration of normal physiology .
Accordingly trauma surgery requires knowledge of anatomy and physiology .
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Between the neck and the thorax .
Between the thorax and the abdomen .
Between the abdomen and the pelvic structures and the groin .
This zones represent surgical challenges in terms of diagnosis of the area of injury and surgical approach .
It is related and balanced against the physiological stability of the patient .
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Patients who have suffered abdominal injury can be generally classified into : Haemodynamiclly Haemodinamiclly normal stable .
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Haemodynamically unstable .
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Cardiovascular status .
Radiological imaging .
Stable patient may be able to have CT scan .
Evaluation of torso trauma .
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CT scan with intravenous contrast most valuable ( however in unstable patient it not always possible ) .
DPL Diagnostic peritoneal lavage .
the presence of > 100 000 red cells /micro liter or > 500 white cells in the peritoneal washout is an indication of intraperitoneal bleeding and this is equivalent to 20 ml of free blood in the abdominal cavity .
Drainage of peritoneal lavage fluids via chest drain is an indication of penetration of diaphragm . M.A.Kubtan
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When positive it means that there is free blood in the peritoneal cavity .
Negativity does not rule out the presence of blood in the peritoneal cavity .
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FAST Focused abdominal sonar for trauma .
FAST is a technique whereby US imaging is used to assess the TORSO for the presence of blood .
This technique focuses on four areas : Pericardial, Splenic , Hepatic , Pelvic .
FAST is accurate for the detection of < 100 ml of free blood in the peritoneom .
It is extremely dependent on the operator experience .
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FAST M.A.Kubtan
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CT is the gold standered for the intra abdominal diagnosis in the stable patient .
CT is performed using intravenous and often oral contrast as well .
CT has the advantages of sensitivity for the diagnosis of retroperitoneal injury .
CT is usually sufficient to exclude injury .
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DL is valuable screening investigation in penetrating trauma .
DL of course in stable patient s following an abdominal or thoraco-abdominal stab wound .
DL is not appropriate for use in the unstable patient .
DL is difficult to exclude all intra-abdominal injuries laparoscopic ally .
DL is not a substitute for open laparatomy especially in the presence of haemoperitonium or contamination.
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Liver The majority of livers injuries occur as a result of blunt injury which may burst liver .
The use of CT for the evaluation of trauma patient ( liver , spleen , kidneys ) .
The liver is a solid organ and may be compressed between the forces and the rib cage or vertebral column.
Penetrating trauma relatively common ( stab wound , bullets cause significant damage ).
Not all penetrating wounds require operative management. M.A.Kubtan
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Push : direct compression .
Pringle : The inflow from the portal triad is controlled by pringle maneuver .
Plug :any holes can be plugged directly .
Pack .
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Occur mainly from penetrating trauma .
Common bile duct injuries often associate with portal vein injury .
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Splenic injury occurs from direct trauma , Overlaying ribs ( ninth to 11 th ribs ) .
Most isolated splenic injuries espacially in children can be managed non operatively .
In adults in the presence of other injuries laparatomy may become indicated depending on physiological instability .
At laparatomy direct splenorrhaphy , or packed , repaired or placed in a mesh bag.
Selective embolisation of spleen can play a role .
Following splenectomy : changes in blood physiology ,raised platelets count > 1000000 , and white cell count rises and mimic sepsis.
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Due to blunt trauma .
CT scan the main test of value .
Amylase may be low or normal ( low amylase in 50% of cases .) .
Treatment : conservative , closed suction drainage , distal pancreatectomy , Wipple,s procedures .
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Renal and urological tract Injury Major abdominal vessels Injury
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Stomach .
Duodenum .
Small bowel .
Colon .
Rectum.
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