TRAUMA - ADULT
ABDO/PELVIS BLUNT
PromptMost important findings on CT - Fall with + FAST
Response
Grade 4 liver laceration - >25% of RIGHT lobe
Active haemorrhage/blush
Haemoperitoneum
Grade 4 liver laceration - >25% of RIGHT lobe
Active haemorrhage/blush
Haemoperitoneum
Prompt26M fall from horse
ResponseCT findings:
Renal parenchymal laceration
Devacularisation parts kidney (hypodense)
Large perinephric haematoma
Management Options
IR – blush identified on arterial phase and IR available
Nephrectomy – severe bleeding / shock not amenable to IR
Conservative – no blush on CT, minimal ongoing transfusion requirement
Complications of this injury
Haemorrhagic shock / death
Urinoma
Abscess
Hypertension
Urinary fistula
Delayed bleeding
Renal parenchymal laceration
Devacularisation parts kidney (hypodense)
Large perinephric haematoma
Management Options
IR – blush identified on arterial phase and IR available
Nephrectomy – severe bleeding / shock not amenable to IR
Conservative – no blush on CT, minimal ongoing transfusion requirement
Complications of this injury
Haemorrhagic shock / death
Urinoma
Abscess
Hypertension
Urinary fistula
Delayed bleeding
PromptAbnormal CT findings
ResponseLeft Devascularised Kidney
Pancreatic Transection
perinephric haematoma
Pancreatic Transection
perinephric haematoma
PromptList outcomes and management to achieve this whilst waiting for theatre
Response
PromptList options for definitive (Non ED) management of abdominal bleeding and their pros/cons
Response
PromptFor blunt abdo trauma list pros and cons for each imaging modality
Response
PromptCT findings seen in mesenteric injuries/seatbelt sign
ResponsePerforation – with leakage of oral contrast (if used), leakage of bowel contents or presence of free intra-abdominal gas
Mural haematoma/mural thickening
Abnormal bowel wall enhancement (e.g. from ischaemia)
Mesenteric injury with active extravasation of contrast
Haziness/fat stranding
Mural haematoma/mural thickening
Abnormal bowel wall enhancement (e.g. from ischaemia)
Mesenteric injury with active extravasation of contrast
Haziness/fat stranding
PromptCommonly missed abdominal/pelvic injuries on CT
ResponseHollow Viscus Injury
Pancreatic Injury
Mesenteric Tear
Site of bleeding with only haemoperitoneum
Pelvic Bleeding unless large amount
Urinary Bladder injuries
Liver capsular injuries
Diaphragmatic Injuries
Pancreatic Injury
Mesenteric Tear
Site of bleeding with only haemoperitoneum
Pelvic Bleeding unless large amount
Urinary Bladder injuries
Liver capsular injuries
Diaphragmatic Injuries
PromptContraindications to performing a FAST scan in trauma
ResponsePresence of a more critical problem e.g. airway obstruction
A clear indication for emergency laparotomy e.g. penetrating abdo trauma with haemodynamic instability
A clear indication for emergency laparotomy e.g. penetrating abdo trauma with haemodynamic instability