MANAGEMENT OF BLUNT

ABDOMINAL TRAUMA AND

FAST SCAN

NOOR NABILAH YUSOP

 Introduction

BLUNT TRAUMA is a non penetrating trauma refers to

physical trauma to a body part either by impact, injury or
physical attack

Identification of intra-abdominal injuries is often

challenging

Many injuries may not manifest during initial assessment

 First Priority: Initial Assessment
Whether the patient is hemodynamically :
1. Stable
2. Unstable

Evaluate ABC along with cardiovascular status with blood pressure and pulse.
Accordingly, manage by :
Control external bleeding
Maintenance of ABC
IV fluids
Nasogastric tube insertion
Catheterization monitor urine output
Dressing over wound
Immobilize patient with fractured bones
Analgesia
 Signs and Symptoms

Pain
Tenderness
Gastrointestinal hemorrhage
Hypovolemia
Evidence of peritoneal irritation
 Second Priorities
Physical examination
Base line investigation
Chest radiograph
Abdominal radiograph
Four quadrant tap
Diagnostic peritoneal lavage (DPL)
Ultrasound (FAST focus assessment with sonography
for trauma)
Abdominal CT scan
Diagnostic laparascopy
Laparatomy
 Physical Examination
1. General examination : hemodynamic stability,
identify all injuries
2. Per Abdomen :
Abdominal distension
Contusion or abrasion
Lap belt ecchymosis : mesenteric, bowel, lumbar spine
injuries
Periumbilical (Cullen sign) and flank (Grey Turner sign)
ecchymosis : retroperitoneal hematoma
3. Per rectal :
Sphincter tone, bleeding, perforation
 Physical Examination (cont)

1. Palpation : tenderness, guarding, rigidity,

rebound tenderness hemoperitoneum
2. Percussion : dullness, shifting dullness
intraabdominal collection
3. Auscultation : presence or absence of bowel
sound in thoracic cavity diaphragm
ruptured
 Diagnostic
Chest Radiograph

Raised hemidiaphragm : perisplenic/hepatic

hematoma
Lower ribs fracture : liver/spleen injury
Abdominal contents in chest : ruptured
hemidiaphragm
 Diagnostic
Abdominal Radiograph

Pneumoperitoneum : perforation of hollow organ

Ground glass appearance : massive hemoperitoneum
Dilated gut loops
Retroperitoneal air outlining right kidney : duodenal injury
Double wall sign : air inside or outside the bowel
Distortion or enlargement of outline of viscera
Medial displacement of stomach : splenic hematoma
Obliteration of psoas shadow : retroperitoneal bleeding
Pelvic bone fracture : bladder/urethral/rectal injury
Fracture vertebra : ureter injury/retroperitoneal hematoma
 FAST Scan Examination
FAST : Focus Assessment with Sonography for
Trauma

Technique :
Four basic position used to find abdominal fluid :
1. Subxiphoid : hemopericardium
2. Right upper abdominal quadrant : fluid in
Morrisons pouch
3. Left upper abdominal quadrant : fluid in
perisplenic space
4. Suprabubic : fluid in Douglas pouch
 FAST SCAN
Advantages :
Easy and early : shorten time to laparatomy
Inexpansive, non-invasive and portable
Avoid risk associated with contrast media
Disadvantages :
A minimum 70ml of intraperitoneal fluid for positive
study
Accuracy is dependent on operator skill
Technically difficult in obese, ileus or subcutaneous
emphysema are present
Sensitivity is low for small bowel and pancreatic injury
Subxiphoid
Right Upper Abdominal Quadrant
Left Upper Abdominal Quadrant
Suprapubic
 Abdominal CT Scan
GOLD Standard
Hemodynamically stable
Provide excellent imaging of pancreas, duodenum,
genital and urinary system
Standard to detect solid organs injury
Determine source and amount of bleeding
Can reveal other associated injury
Contraindication :
Clear indication for laparatomy
Hemodynamically unstable
Allergy to contrast
 Laparascopy
Hemodynamically stable patient
Persistent abdominal signs/symptoms
Able to determines extent of organ injuries and need for laparatomy
Determines which intraabdominal injuries may be safely managed non-
surgically
Surgery can be done in the same sitting

Disadvantages :
Retroperitoneal injury
In pneumoperitoneum may elevate ICP
Patient must be hemodynamically stable

Complications :
Bleeding or injury to other organs
Gas embolism and pneumoperitoneum
 Laparatomy
Indications:
Peritonitis (gross blood, bile or feces)
Pneumoperitoneum or
pneumoretroperitoneum
Evidence of diaphragm defect
Gross blood from stomach or rectum
Abdominal distension with hypotension
Positive diagnostic test for operative repair
 Non Operative Management

Patient hemodynamically stable after initial

resuscitation
Continuous patient monitoring for 48 hours
Absence of peritonitis
For observation, serial investigation and
repeat imaging
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