Wednesday, April 25, 2018

Step 2 CK: Blunt abdominal trauma


When you are presented with a case of blunt abdominal trauma (BAT) in your exam, first determine whether the patient is stable or unstable.

If unstable - resuscitate!

In hemodynamically unstable patients with BAT, management depends on: presence or absence of intraperitoneal hemorrhage. 

Therefore, focused abdominal ultrasound (US) exam (or in some instances a diagnostic peritoneal tap [DPT]), to make this determination.

If hemoperitoneum: Laparotomy.

No hemoperitoneum: Search for extra-abdominal sites of hemorrhage.

If stable - assess risk for abdominal injury.

Low-risk: Assessed by clinical presentation, vital signs, and laboratory tests (no anemia, elevated transaminase concentrations [if obtained], or hematuria)
Management: Nine-hour period of observation - serial vital signs and abdominal examinations.

High-risk: Assessed by clinical presentation, laboratory findings associated with intra-abdominal injury (hematocrit < 30 percent, AST or ALT > 130 units/L, microscopic hematuria > 25 red blood cells [RBCs] per high power field)
Management: CT scan is the preferred modality for identifying such injuries.

Blunt abdominal trauma algorithm for step 2 CK

That's all!

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