Abdomen & pelvic trauma

mechanism
Blunt trauma
Organ rupture (liver, lymph, small
intestine) bleeding Crushing &
compression
Intestine rupture peritonitis
Wrong seatbelt position shearing
injury
Deceleration injury
Sharp trauma
Stab wound, gunshot wound
 Assessment
1. Anamnesis
Acceleration, collision mechanism, seatbelt? (traffic
accidents)
Pre-hospital vital sign
Time of trauma, weapon type, number of stab wounds,
etc
2. Physical exam
Inspection (abrasion, contusion, hematoma)
Palpation & percussion (peritoneal irritation,
involuntary muscle guarding)
Pelvic stability (manual compression, x-ray)
Urethra, perineum, rectal (blood in MUE urethra
laceration, hematoma scrotum/ perineum, RT)
 Other physical exams
NGT
gastric decompression to prevent aspiration
Blood if upper respiratory tract/ GIT injury
happened
Contraindication: facial trauma
Urine catheter
Prevent urine depression
VU decompression
Monitor urine output
 Other examinations
Thorax & pelvis x-ray Diagnostic
FAST (focused
peritoneal lavage
assessment sonography
in trauma) 2nd fastest
The fastest exam to identify Invasive
bleeding & organs ihjury
Used for unstable
Using USG
Can detect heart hemodynamic
tamponade, patients & multiple
hemoperitonium, blood in blunt trauma
cavum douglass
Control after 30 mins after
Contraindication :
1st exam to check for slow indication for
bleeding laparotomy
 DPL
1. Install catheter first to see if theres any
bleeding or intestinal contents in the
abdominal/ pelvic cavity
2. If theres no bleeding or intestinal contents,
lavage with warm cristalloid solution 1000 ml
3. Log-roll the patient
4. Send the lavage fluid to lab
5. The result is positive if theres >100.000
rbc/mm3, 500 wbc/mm3, bacteria on gram
colloring
https://www.researchgate.net/figure/6964671_fig2
_Figure-1-Algorithm-for-the-initial-treatment-of-
pelvic-fractures-in-blunt-high-energy
 Thorax trauma 1 survey st

Airway airway obstruction (stridor,

bad voice quality), muscle retraction
Breathing increased, shallow
breathe, cyanosis hypoxia sign
Circulation (pulse pressure, blood
pressure, HR, peripheral circulation,
neck vein disention)
 Cause of breathing
problems
Tension Open pneumothorax
pneumothorax 3 side occlusive dressing
Chest pain, air Chest tube
hunger, respiratory Lung contusion
distress, HR, multiple costae fracture
hypotension, flail chest
tracheal deviation, Disturbance in chest wall
movement (asymmetrical
loss of breath sound,
& unorganized), costae
neck vein distention crepitation, fracture line
Decompresion on x-ray
Chest tube Ventilation, O2,
crystalloid, analgesics
TENSION PNEUMOTHORAX

American College of Surgeons

Committee on Trauma. Advanced
trauma life support (ATLS) for
doctors: student course manual.
9th ed. Chicago: American College
of Surgeons; 2012.
OPEN PNEUMOTHORAX

American College of Surgeons

Committee on Trauma. Advanced
trauma life support (ATLS) for
doctors: student course manual.
FLAIL CHEST

American College of Surgeons

Committee on Trauma. Advanced
trauma life support (ATLS) for
doctors: student course manual.
HEMOTORAKS MASIF

American College of Surgeons

Committee on Trauma. Advanced
trauma life support (ATLS) for
doctors: student course manual.
TAMPONADE JANTUNG

American College of Surgeons

Committee on Trauma. Advanced
trauma life support (ATLS) for
doctors: student course manual.
MANAJEMEN TRAUMA TORAKS YANG
MENGANCAM JIWA
Obstruksi jalan napas
Bebaskan jalan napas
Imobilisasi vertebra servikal
Tension pneumothorax
Dekompresi kavitas pleura

American College of Surgeons Committee on Trauma. Advanced trauma life support (ATLS) for doctors:
student course manual. 8th ed. Chicago: American College of Surgeons; 2008.
American College of Surgeons Committee on Trauma. Advanced trauma life support (ATLS) for doctors:
student course manual. 9th ed. Chicago: American College of Surgeons; 2012.
DEKOMPRESI

American College of Surgeons

Committee on Trauma. Advanced
trauma life support (ATLS) for
doctors: student course manual.
MANAJEMEN TRAUMA TORAKS YANG
MENGANCAM JIWA
Open pneumothorax
Pemasangan flutter valve dressing
Flail chest dan kontusio paru
Resusitasi cairan dan analgesik yang
adekuat
Intubasi selektif

American College of Surgeons Committee on Trauma. Advanced trauma life support (ATLS) for doctors:
student course manual. 8th ed. Chicago: American College of Surgeons; 2008.
FLUTTER VALVE DRESSING

American College of Surgeons

Committee on Trauma. Advanced
trauma life support (ATLS) for
doctors: student course manual.
MANAJEMEN TRAUMA TORAKS YANG
MENGANCAM JIWA
Hemotoraks masif
Evakuasi dengan pemasangan chest
tube ukuran besar (36 F)
Torakotomi
Tamponade jantung
Resusitasi cairan dan bedah
Bedah tidak dapat dilakukan segera
perikardiosentesis

American College of Surgeons Committee on Trauma. Advanced trauma life support (ATLS) for doctors:
student course manual. 8th ed. Chicago: American College of Surgeons; 2008.