01 Trauma

Abdomen

Penetrating

• Always go to OR

• Gunshot: always penetrate peritoneum. Ex lap

• Knife:

  • peritoneal signs, shock, evisceration = OR

  • superficial wound: probe wound. If enter peritoneum, OR. If not penetrated, watch and wait.

• Abd begins at T4 nipple

Blunt

• always do FAST

  • positive: OR

• CT as alternative

  • blood/air: OR

• KUB: not right

• DPL: not right

• Pelvis, abdomen, thigh hold the most amount of blood, enough to die

• causes of bleed

  • ruptured liver, most common, shredded by ligament with force stop. Repair or lobectomy, pringle maneuver

  • ruptured spleen: has capsule. Can usually pack it and repair. Can also resect if bad. Vaccinate afterwards

  • diaphragm: bowel in chest. OR

  • ruptured viscous: air under diaphragm on KUB. Free air on CT at top of scan.

• Pelvic fx

  • enormous amount of trauma. MVC

  • hip rocking: pain, instability. CT scan

  • external fixation. Not OR unless in peritoneum.

  • look for urethral trauma, high riding prostate, blood at meatus. Don't put in folley. Diagnosis with retrograde urethrogram.

  • Rectal injury: proctoscope

  • ureteral injury: assess with intravenous pyelogram

Toxic Ingestion

Alcohol	Ingested	AG	Osmolar gap	Tx
Ethanol	alcohol drinks	-	+	supportive
Isopropyl	rubbing alcohol. Cleaner	-	+	Supportive
Ethylene	Antifreeze, renal failure, wood's lamp dx	+	+	Fomeprazole/etoh
Methanol	Blindness, moonshine	+	+	Fomeprazole/etoh

• hyponatremia w/ nl serum osmolality and low calculated serum osm

Acetaminophen

• pain pills

• drug induced liver injury

• AST/ALT > 1000

• Dx: acetaminophen level

• rx: n-acetylcsteine, transplant if liver failure

Salicylates

• aspirin

• early: tinnitus, N/V, respiratory alkalosis, vertigo

• late: AG acidosis, obtounded, coma, hyperpyrexia

• diagnosis: salicylates level

• treatment: alkalization of urine, force diuresis

CO

• smoke inhalation

• 100% pulse ox, hypoxemic

• headache, N/V, delirium

• diagnosis: ABG measure Carboxy Hb

• treatment: 100% FiO2, hyperbaric

Cyanide

• nitroprusside, fire, smoke

• really sick, obtounded, heavy lactic acidosis, cherry red

• diagnosis: cliinical

• treatment: thiosulfate, amyl nitrate (Avoid because may have CO co-toxicity)

Organophosphate

• weapons of terror, pesticides, neostigmine/MG

• SLUDGE: salivation, lacrimation, urination, defecation, GI upset, emesis. Bronchoconstriction

• clinical diagnosis

• treatment: atropine, pralidoxime