Fast in penetrating abdominal trauma. World J Surg 2013; 37:113.

Fast in penetrating abdominal trauma suhailamer@yahoo. Some centers have used positive FAST examination findings as an indicator for laparotomy in penetrating trauma. The indications of FAST are haemodynamically unstable patients with suspected abdominal injury and those with significant extra-abdominal injuries (orthopaedic, spinal, chest Jul 24, 2023 · Intraperitoneal bleeds occur in 12 percent of blunt trauma; therefore, it is essential to identify trauma quickly. Apr 17, 2009 · Peck JJ, Berne TV. 29 30 In our study, 9 of the 15 patients that had penetrating injuries and a false negative FAST underwent laparotomy with control of Aug 26, 2024 · SNOM is a viable approach for appropriately selected patients with penetrating abdominal trauma. Thoraco-abdominal penetrating abdominal injury: An entry wound below the fifth intercostal space and above the costal margin. Diagnostic tools that help the treating doctor in optimum management of blunt abdominal trauma include; Focussed Assessment Sonography for Trauma (FAST), Diagnostic peritoneal lavage (DPL) and CT scan. Nursing Points General Common mechamisms of injury Clinical History Assessments Warning signs of major complications Common injuries Stabbing Gun Shot Wounds Impailment Interventions in the trauma bay Assessment Similar for all […] Jun 23, 2013 · www. 1,2 Hypotensive patients with penetrating abdominal trauma may benefit from bypassing the trauma bay completely and going directly to the operating room, thus 28. Eur J Trauma Emerg Surg. Research on these remain scarce. Penetrating trauma in children. 4% blunt / 7. There is no standard generalizable classification; however there have been guidelines and algorithms proposed [6, 45, 46]. 30% of the original amount of instilled fluid is required for an adequate sample. Approximately 75% of blunt abdominal trauma are related to motor vehicle collisions or auto versus pedestrian accidents. Jan 2, 2023 · Focused abdominal sonography for trauma (FAST) in the trauma bay detects peritoneal fluid, but not the specific source. Optimal diag- Mar 30, 2022 · Examination of the abdomen in a patient who is awake may indicate peritoneal signs, such as pain and guarding and rebound tenderness. 5 Penetrating chest injuries account for 1%-13% of thoracic trauma admissions. Curr Opin Crit Care Feb 17, 2015 · A FAST exam is most helpful in penetrating abdominal trauma patients while whole body CT should be considered in stable major trauma patients with significant mechanisms. In the USA, 90% of deaths related to penetrating abdominal injury (PAI) are caused by GSW. com www. Case Summary. Nov 3, 2020 · Trauma Professional’s Blog — How to read a stab wound; Trauma Professional’s Blog — CT evaluation of stab wounds; Trauma! Initial Assessment aA Q&A guide to the assessment and management of penetrating abdominal trauma, including stab wounds, gunshot wounds and different regions of the abdomen. 24 In contrast, in patients with penetrating anterior thoracoabdominal trauma, the subxyphoid window is very useful for identifying pericardial fluid . X-ray wavelengths range from 1 pm to 10 nm. Jun 3, 2021 · For blunt abdominal trauma, sensitivities generally range from 73–99% for detecting free intraperitoneal fluid. Mar 14, 2017 · Focused assessment with sonography in trauma (FAST) has been extensively utilized and studied in blunt and penetrating trauma for the past 3 decades. Oct 17, 2019 · The FAST exam is more useful for patients following blunt trauma. Seng Apr 1, 2001 · Focused Assessment with Sonography for Trauma (FAST) can be a useful initial diagnostic study after penetrating abdominal trauma. J Trauma 2005; 58:789. 29–31 Some authors have found the higher rate of false negative FAST examinations in penetrating trauma to be predominantly due to hollow viscus injuries. Keywords: laparoscopy, laparotomy, blunt trauma, penetrating trauma, meta-analysis. 8,25 It is more sensitive than specific when evaluating pathology in the pleural and pericardial spaces compared with the Anterior penetrating abdominal injury: An entry wound on the anterior abdomen or chest that could have penetrated into the peritoneal cavity. USS not validated for penetrating trauma; If free fluid is seen on FAST, this would be an indication for further evaluation; A negative FAST does not rule out intraabdominal injury in penetrating trauma; For patients with upper abdominal stab wounds or any projectile wound: if unstable – eFAST can be utilised to rapidly assess for cardiac Combat surgeons frequently encounter Abdominal Trauma (AT), mostly penetrating and occasionally blunt. 2 y Spleen (40–55%) y Liver (35–45%) y Small intestine (5–10%) The causes of abdominal trauma based on age are given in Jul 1, 2022 · To the authors' knowledge, no study has examined the role of FAST in a cohort with a high proportion of penetrating injury. The use of diagnostic peritoneal lavage (DPL) as an adjunct in the management of these patients was subsequently reported by Thal [ 12 ] in 1977. Prior to FAST, invasive procedures such as diagnostic peritoneal lavage and exploratory laparotomy were commonly utilized to diagnose intraabdominal injury. Boulanger BR, Kearney PA, Tsuei B, Ochoa JB. e. Cotton BA, Nance ML. Deaths caused by blunt trauma are frequently the result of diagnostic difficulties and treatment delays. Overall, this is generally better evaluated by CT, however ultrasound can be helpful in initial bedside evaluation and aid in prioritization of further therapy/diagnostics Udobi et al 15 found FAST to be quite specific (94%) in patients with penetrating abdominal trauma. Gunshot wounds in the abdominal region can range from minor wounds to severe traumatic injuries depending on the anatomical structures the bullet penetrates. 2004 May. 2017 Jul 20. 1; Gunshot wounds (GSWs) and stab wounds cause 90% of penetrating abdominal injuries. The modified procedure of diagnostic peritoneal aspirate (DPA) is useful in the hemodynamically unstable abdominal trauma with a negative FAST scan — a positive DPA indicates a false negative FAST scan and such patients require emergency laparotomy. Even though most gunshot wounds typically have a linear Mar 4, 2022 · The clinical assessment for a patient with suspected intestinal injury begins with the primary survey to assess life-threatening injuries. Selective conservativism in penetrating abdominal trauma. Jun 3, 2023 · Penetrating abdominal trauma is most commonly caused by stabbing or gunshot wounds. Design: A Oct 7, 2022 · Moreover, although trauma surgeons usually directly perform FAST exams in the trauma bay, there was no official education program for the FAST examination in our center. New York: The McGraw-Hill Company, 2011: pg 193. A plain abdominal radiograph confirmed the presence of a single nail in the abdomen. 3 to 27% for gunshot wounds. Logroll patients with c-spine stabilization and check back, axilla, groin and buttocks as these areas are often overlooked May 21, 2022 · Focused Assessment with Sonography for Trauma (FAST) predicts the presence of pericardial or intra-abdominal injury after penetrating or blunt trauma. Mar 27, 2023 · The incidence of hospitalization from PAT in urban trauma centers is about 35% and 12% in rural settings. Details of the Abdominal Trauma Mechanism are Crucial. Abstract Background. 3,8,24 The specificity of the FAST exam for both blunt and penetrating abdominal trauma is 94–100%. 13(2):87-97. 3 to 53% for stab wounds, and from 5. Jun 1, 2022 · While penetrating injury to the back and flank (posterior to the anterior axillary lines) has a lower likelihood of significant intra-abdominal injury compared to anterior abdominal or thoracoabdominal wounds, it is difficult to evaluate the retroperitoneum with physical exam and FAST. FAST is used for hemodynamically unstable patients after blunt abdominal trauma (bc they’re too unstable to make it to the CT machine) *if there are ever signs of peritonitis (guarding, rebound, etc) -> straight to the OR Oct 13, 2024 · Focused Assessment with Sonography for Trauma (FAST) scan is a point-of-care ultrasound (POCUS) examination performed at the time of presentation of a trauma patient. The implementation of point of care ultrasound has significantly impacted the evaluation and treatment of patients. Penetrating abdominal trauma: FAST has less of a role, given the incidence of bowel and other intra-abdominal injury not detected by ultrasound. doi: 10. In Europe, blunt trauma connected with either automobile accidents or falls from height is the most common cause of severe injuries, while penetrating wounds are less frequent. This episode covers some of the diagnostic and management dilemmas in patients with blunt and penetrating abdominal trauma - a high yield action packed episode that can't be missed! Shownotes - PDF Link [bg_faq_start] Rosen’s in Perspective Principles to consider with any Jan 11, 2023 · Abdominal trauma accounts for 7–10% of hospital admissions due to trauma. Only a few reports have described the use of angiography in this setting. Laparotomy became the Nov 7, 2022 · Early computed tomography or focused assessment with sonography in abdominal trauma: what are the leading opinions?. 1). Jan 1, 2025 · Role of preoperative CT imaging in penetrating thoraco-abdominal injuries: A multicenter study of urban trauma centers Author links open overlay panel Madison Harris a , Toba Bolaji b , Steven DiStefano c , Keshab Subedi d , John Getchell e , Kristen Knapp f , Aara Sheth g , Tanya Egodage f , Zaheer Faizi h , Joseph Morales h , Sirivan S. [Google Scholar] Berne TV. Management guidelines for penetrating abdominal trauma. It discusses the anatomy, mechanisms of injury, assessment techniques like the FAST scan and CT scan, management principles, and specific injuries to the liver, spleen, diaphragm, and pelvis. Penetrating abdominal injury with positive fast is going to need an exploration period. Incidentally, blunt abdominal trauma has greater mortality than PAI (more difficult to diagnose, commonly associated with trauma to multiple organs/systems). The most common organs injured are the small bowel (50%), large bowel (40%), liver (30%), and intra-abdominal vascular (25%). Today the FAST examination has evolved into a more comprehensive study of the abdomen Management of penetrating abdominal trauma Back/Flank Risk of retroperitoneal injury Intraperitoneal organ injury 15- 40% Difficulty evaluating retroperitoneal organs with exam and FAST In stable pts, CT scan is reliable for excluding significant injury: Biffl et al. Wide mediastinum (aortic injury) 9) Provide an approach to anterior abdominal trauma with: a. A substantial proport … Jul 24, 2023 · All indications for trauma ultrasound include blunt or penetrating trauma to the torso where there is a suspicion of intraperitoneal hemorrhage, pericardial tamponade, and hemothorax. When a patient is in the supine position the most dependent area in the upper peritoneum between the liver and right kidney, also known as Morison's pouch, and the most dependent area in the lower peritoneum is posterior to the bladder in the male and the pouch of Douglas (posterior to the uterus) in the female. Abdominal injuries following trauma may occur in isolation or as part of polytrauma depending on the mechanism. 1% to 100%. Before World War I, penetrating trauma was managed expectantly and was nearly uniformly fatal. Angiography may be necessary as an adjunct to initial nonoperative management of penetrating abdominal trauma. com When to do CT • Blunt abdominal trauma – Stable patients with positive FAST – Stable patients with negative FAST but suspicious for injuries (by clinical or labs) • Penetrating abdominal trauma – Stable patients with injury to back & flank – (stable patients with thoracoabdominal & anterior Jul 1, 2022 · Focused Assessment with Sonography for Trauma (FAST) is a bedside tool often used in blunt and penetrating abdominal trauma, which has largely replaced diagnostic peritoneal lavage to detect intraperitoneal hemorrhage . Dec 30, 2024 · A focused assessment with sonography for trauma (FAST) scan is particularly useful for the rapid detection of intra-abdominal and pericardial fluid 7-12 as well as the recognition of penetrating cardiac injuries. Positive FAST in penetrating abdominal trauma indicates intraperitoneal bleeding and may warrant laparotomy. The most commonly injured regions are the small bowel, large bowel, liver, and intra-abdominal vasculature. [QxMD MEDLINE Link]. Focused assessment with sonography in trauma (commonly abbreviated as FAST) is a rapid bedside ultrasound examination performed by surgeons, emergency physicians, and paramedics as a screening test for blood around the heart (pericardial effusion) or abdominal organs (hemoperitoneum) after trauma. This is the first time this has been demonstrated in a cohort containing children with penetrating abdominal trauma. When the injury is close range, there is more kinetic energy than those injuries sustained from a distance. Feb 22, 2024 · INTRODUCTION — . Pros Dec 6, 2022 · Back ground Penetrating abdominal trauma typically involves the violation of the abdominal cavity by a gunshot wound (GSW) or stab wound. Role of ultrasonography in penetrating abdominal trauma: a prospective clinical study. 1% PPV. This is a simplified summary of a typical FAST examination assuming no trauma. These injuries may be confounded by altered mental status secondary to head trauma, distracting injuries, delayed presentation and lack of historical information, and hence may present challenges in management. For quick recap, primary survey includes: A = Airway; B = Breathing; C Penetrating Abdominal Trauma, Selective Non-Operative Management of 2010; Penetrating Combined Arterial and Skeletal Extremity Trauma, Management of 2002; Penetrating Intraperitoneal Colon Injuries, Management of 2019; Penetrating Lower Extremity Arterial Trauma, Evaluation and Management of 2012; Penetrating Neck Injuries, Management of 2008 Oct 15, 2014 · Introduction The optimal management of patients with penetrating abdominal injuries has been debated for decades, since mandatory laparotomy (LAP) gave way to the concept of “selective conservatism. Because 85. 4% of all patients with trauma and in 37. Patients who are haemodynamically decompensated with a positive Focused Assessment with Sonography for Trauma (FAST) should proceed directly to a trauma laparotomy to stop major abdominal bleeding and, if applicable, other sources of bleeding (e. 3% sensitive, 97. Key Words—completeness; emergency medicine; FAST; pediatric; trauma Background Intra-abdominal injury secondary to blunt abdominal trauma remains one of the leading causes of preventable death in children in the United States. This article will define the problem of PAT and review the initial management, including the ability to identify, resuscitate, and initiate treatment in patients with unstable PAT prior to their transfer to the operating room (OR). " To aid initial diagnosis, investigation and management, abdominal trauma can be broadly grouped into penetrating or blunt, depending on the mechanism of injury. 5% specific with 98. Nov 1, 2010 · In urban trauma centers, penetrating abdominal trauma comprises 35% of the population, while only 12% of those in suburban or rural setting are penetrating. If negative, additional diagnostic studies should be performed to rule out occult injury. 1981; 21:298–306. 140 patients with non-penetrating abdominal trauma referred to Razi Hospital were selected who underwent FAST technique for the intervention group and CT scan with injection for the control group. 29–31 Some authors have found the higher rate of false negative FAST examinations in penetrating trauma to be predominantly due to hollow viscus injuries. Jul 1, 2012 · Penetrating abdominal trauma (PAT) has the potential to be a devastating injury and ranks in the top 15 causes of death for all ages. . don’t forget the diaphragm) . 1097/00005373-198104000-00007. Parasternal long axis-view; Abdominal and Lower Thoracic Views. 1 Unfortunately, early and accurate diagnosis of intra-abdominal injury in children is challenging. 29 30 In our study, 9 of the 15 patients that had penetrating injuries and a false negative FAST underwent laparotomy with control of hemorrhage Jan 12, 2023 · Abdominal trauma is a major cause of morbidity and mortality in all age groups. , pelvic Oct 2, 2024 · This study aimed to evaluate the accuracy and outcomes of focused assessment with sonography for trauma (FAST) and determine the factors associated with true-positive FAST results. Unless there is clear evidence that laparotomy is indicated or the mechanism of injury is minor, imaging (typically ultrasonography or CT) is typically required after blunt or penetrating trauma. Feb 14, 2015 · A FAST scan (Focused Assessment with Sonography for Trauma) was positive. 6 A review by Mandal and Sanuzi found a 6. Feb 15, 2020 · Blunt abdominal trauma is more difficult to diagnose than penetrating trauma and can involve multiple organs. BOX 1: Organs most frequently affected due to blunt abdominal trauma. • Any blow to the abdomen or penetrating injury to the Sep 10, 2024 · Penetrating abdominopelvic trauma usually occurs in the setting of gunshot and stab injuries and is associated with high morbidity and mortality. Blunt and penetrating injuries can cause damage to solid organs like the spleen, liver, and pancreas. • Presence of pancreatic and solid organ injury are predictive of increased risk for hollow viscus injury. Focused Assessment with Sonography in Trauma (FAST) in 2017: What Radiologists Can Learn. 11 Its main utility in penetrating injuries is rapid evaluation of the pericardium. The use of laparoscopy on patients with trauma was first reported in the 1970s . Introduction. Mar 30, 2022 · Cotton BA, Nance ML. Nov 15, 2024 · The evaluation of blunt or penetrating abdominal trauma can be one of the most challenging and resource-exhaustive aspects of acute trauma care. It is indicated to hemodynamically unstable patients with blunt abdominal trauma, with penetrating trauma of the thoracoabdominal transition (where there is doubt of penetrating the abdominal cavity) and for any patient with the cause of the instability unknown. Diagnosis of blunt abdominal trauma is a real challenge even for experienced trauma surgeons. Jan 24, 2023 · Negative FAST, low risk for intra-abdominal injury → observation; Negative or equivocal FAST with high risk for intra-abdominal injury → CT scan; X-ray X-ray Penetrating electromagnetic radiation emitted when the inner orbital electrons of an atom are excited and release radiant energy. Apr 10, 2023 · penetrating trauma. A 38-year old male was transferred to a Level 1 Trauma Center from a peripheral Emergency Department. FAST can be a useful initial diagnostic study after penetrating abdominal trauma. Figure 4 After fluid is instilled, the bag is placed onto the floor to allow the intraabdominal fluid to return . *Pretty much never going to do FAST for penetrating trauma. Blunt abdominal trauma (BAT) is regularly encountered in the emergency department (ED). Most abdominal trauma in our region is caused by blunt mechanism, although penetrating injuries overall are rising. 6,7 In patients suffering from penetrating abdominal trauma, NOTs can be safe in select patients. The use of DPL as an adjunct in management of penetrating abdominal trauma was subsequently reported by Thal in 1977 [64]. Watch Out Abstract Background. Similarly, DPL is more useful for blunt abdominal trauma, specifically if FAST is unavailable or equivocal. Methods. Jun 3, 2023 · Penetrating abdominal trauma is seen in many countries. Abdominal trauma is commonly encountered in emergency departments and can be life-threatening. , the primary survey followed by the secondary survey. 13 However, there is no systematic review that has evaluated the utility of the Focused Assessment with Sonography for Trauma(FAST) exam in penetrating torso trauma. The role of the FAST examination in penetrating abdominal trauma remains unclear, as neither a positive nor negative result appears to reliably predict the need for operative intervention. Pelvic fracture b. Radiology. Jan 1, 2014 · The goal of managing patients with penetrating abdominal trauma is to quickly and efficiently assess injuries and establish treatment priorities (Fig. Hemodynamically stable patients with penetrating abdominal trauma and peritonitis can be assumed to have a hollow visceral perforation and may have significant intra-abdominal hemorrhage. Over the past few years, the management of patients with penetrating abdominal has changed. 3% of patients with severe trauma, but which specific abdominal organs were damaged by which trauma mechanism and at what rate surgical intervention was performed were not investigated. 283 (1):30-48. 1% to 100%, but the specificity is very high from 94. Especially useful in patients with penetrating thoracic trauma and in unstable patients after blunt abdominal trauma. 3% to 100% and 81 to 84%, respectively). In 1988, the American Association for the Surgery of Trauma (AAST) devised a set of organ injury scales (OISs) based on findings at surgical exploration. Management of penetrating back trauma. Oct 24, 2016 · This episode of CRACKCast covers Chapters 46 of Rosen’s Emergency Medicine, Abdominal Trauma. May 21, 2021 · Penetrating abdominopelvic trauma usually results from abdominal cavity violation from a firearm injury or a stab wound and is a leading cause of morbidity and mortality from traumatic injuries. Focused Assessment Sonography for Trauma (FAST) being non invasive should be the first step in assessment of patients with blunt abdominal trauma, when complimented by DPL may helps in defining the organ injury. Study objective: A recent Cochrane Review has demonstrated that emergency ultrasonography decreases the amount of computerised tomographic scans in blunt abdominal trauma. RiTradiology. It is invariably performed by a clinician, who should be formally trained, and is considered as an 'extension' of the trauma clinical assessment process, to aid rapid decision making. Jan 18, 2024 · Abdominal Trauma. Dec 7, 2021 · The modified procedure of diagnostic peritoneal aspirate (DPA) is useful in the hemodynamically unstable abdominal trauma with a negative FAST scan — a positive DPA indicates a false negative FAST scan and such patients require emergency laparotomy In penetrating abdominal trauma, the reported sensitivity of FAST ranges from 28. [16][32] Velmahos in 1999 described 40 patients undergoing angiography after penetrating abdominal trauma. [32] Sonographic examination of abdominal trauma by senior surgical residents. Penetrating trauma can have subtle or complex imaging findings, posing a diagnostic challenge for radiologists. CT is the modality of choice in imaging if the patient is stable enough before surgery. [1] While the leading cause of blunt abdominal trauma-related deaths in the It is indicated for the triage of blunt trauma patients (7) to direct decision making (1). Aside from this, the utility of FAST for penetrating abdominal trauma is limited. A positive FAST is a strong predictor of injury, and patients Oct 13, 2024 · Focused Assessment with Sonography for Trauma (FAST) scan is a point-of-care ultrasound (POCUS) examination performed at the time of presentation of a trauma patient. BLUNT ABDOMINAL TRAUMA Blunt abdominal trauma commonly results from either a compression force or a deceleration injury. Most hemodynamically stable injuries can be managed non-operatively Feb 5, 2019 · Patients who sustained high -energy penetrating abdominal trauma (gunshot wounds) and are hemodynamically stable, without free fluid on FAST, warrant computerized tomography to further elucidate the path of the bullet and any associated injuries. 2017 Apr. Trauma (main) Trauma in pregnancy; Thoracic and lumbar spine trauma; References. This positive result allows the surgeon to assume that the abdominal cavity is the source of his instability. Blunt Abdominal Trauma (ACEP Clinical Policy 2011) Penetrating Abdominal Trauma. Assessment • Clinical signs may not be apparent initially. The most common cause is a stab or gunshot. Jun 1, 2015 · Introduction: The optimal management of patients with penetrating abdominal injuries has been debated for decades, since mandatory laparotomy (LAP) gave way to the concept of "selective conservatism. FAST should be used liberally in the evaluation of trauma patients. Historically, all patients with penetrating abdominal trauma underwent laparotomy, but this often resulted in a high rate of negative/non-therapeutic laparotomy, ranging from 2. [Google Scholar] Shaftan GW. If there is no Penetrating abdominal trauma (15%) y Stab wounds y Gunshot wounds Organs most frequently affected due to blunt abdominal trauma are given in Box 1. Depending on the mechanism of occurrence, abdominal traumas are classified as either blunt or penetrating. However, even a stable patient with negative imaging work-up could have underlying abdominal injury (i. Patients with severe non-penetrating trauma and patients for whom FAST technique was performed in the emergency Sep 25, 2024 · The term "Focused Abdominal Sonography for Trauma" was coined in 1996 to describe a standard set of ultrasound examinations for the evaluation of injured patients. Oct 7, 2022 · This study aimed to evaluate the accuracy and outcomes of focused assessment with sonography for trauma (FAST) and determine the factors associated with true-positive FAST results. Evaluation of abdominal trauma involves primary and secondary surveys including history, physical exam, diagnostic tests like FAST, CT scans, and exploratory laparotomy if indicated. In case of any trauma, you need to go serially as per ATLS guidelines, i. 11. The low-frequency transducer is the most appropriate probe for the FAST exam. This must occur immediately if the child is hemodynamically abnormal. Penetrating abdominal trauma is seen in many countries. Goaley, David V. May 4, 2022 · Focused Assessment with Sonography for Trauma (FAST) is a bedside tool often used in blunt and penetrating abdominal trauma, which has largely replaced diagnostic peritoneal lavage to detect intraperitoneal hemorrhage . [ 15 , 16 ] That is, a positive FAST result in the setting of penetrating trauma is usually an indication for laparotomy due to the high positive predictive value for a therapeutic laparotomy. Apr 29, 2024 · FAST is less sensitive for injury in penetrating trauma than blunt trauma, and the results of ultrasound examinations in penetrating trauma patients, particularly negative results, must be interpreted with caution. 7 In shallow posterior penetrations such as a stab wound, deep organs are Overview With penetrating abdominal traumas, even though we can see the external injuries, we can not forget the possible concurrent injuries that can occur. Focused assessment with sonography in trauma (FAST) has been extensively utilized and studied in blunt and penetrating trauma for the past 3 decades. The Extended Focused Assessment with Sonography for Trauma (EFAST) exam includes the following views: Aug 2, 2007 · CT is also increasingly used for penetrating trauma, which traditionally was evaluated operatively, but the CT-results should be interpreted with caution as the sensitivity and specificity in penetrating abdominal injury is lower than for blunt trauma (31. Sep 19, 2018 · Hemodynamically unstable patients sustaining blunt or penetrating trauma with a positive screening test [such as focused assessment with sonography for trauma (FAST) examination or diagnostic peritoneal lavage (DPL)] require laparotomy to control hemorrhage and evaluate for intra-abdominal injuries. Head injury (closed head injury) c. Jun 19, 2023 · There are four regions to be examined in the traditional FAST protocol: pericardium (to detect cardiac tamponade), right upper abdominal quadrant, left upper abdominal quadrant, and pelvis (to detect hemoperitoneum). The focus of the primary survey is resuscitation with continuous assessment of vital signs and control of hemorrhage. Western Trauma Association: Penetrating Chest Trauma (J Trauma Acute Care Surg 2014) Blunt Abdominal Trauma. Contrast-enhanced CT is the modality of choice for evaluating penetrating injuries, with Mar 19, 2015 · 3. • Blunt vs penetrating • Signs of peritonitis develop. nd Management Penetrating abdominal trauma: observation and nonoperative management. A subsequent CT scan showed that the nail was positioned within the transverse colon with free air and fluid surrounding the liver, spleen and paracolic gutters, and a perforation of the Apr 1, 2020 · Severe abdominal trauma is diagnosed in up to 20% of severe trauma patients and is associated with a high mortality rate of around 20% [1]. J Trauma. While FAST has been found to be 94-98% specific for abdominal injury in penetrating abdominal trauma, its sensitivity of 46-67% is not good. O'Malley E, Boyle E, O'Callaghan A, et al. Penetrating abdominal trauma usually requires operative treatment. Nov 3, 2020 · It’s main role is when FAST and CT are unavailable or in mass casualty situations. The management options are also vast; therefore, providers must understand the evaluation, diagnosis, and management of intestinal injury. African-American males have a 3-fold increase in relative risk of death compared with their White male counterparts. Mar 8, 2009 · Algorithms for using DPL, FAST, and CT scanning in both penetrating and blunt abdominal trauma are shown in Figures 5 and 6. Penetrating Abdominal Trauma (LITFL 2019) EAST on Selective Non-Operative Management of Penetrating Sep 10, 2024 · Penetrating abdominopelvic trauma usually occurs in the setting of gunshot and stab injuries and is associated with high morbidity and mortality. World J Surg 2013; 37:113. The patient is in a supine position. ) 7) List clinical indications for laparotomy in blunt and penetrating abdominal trauma 8) Describe the management of unstable blunt abdominal trauma a. The lack of historical data and the presence of distracting injuries or altered mental status, from head injury or intoxication, can make these injuries difficult to diagnose and manage. Before the advent of antibiotics and aseptic techniques, penetrating abdominal injuries were managed expectantly with poor outcomes. In the initial stage, the Through careful selection of patients, large trauma centers showed good results in the conservative treatment of blunt abdominal trauma presenting with hemodynamic stability and solid organ damage, without injury to hollow viscera. ” Materials and Methods A comprehensive literature review was performed and summarized. Nov 19, 2014 · Management of penetrating abdominal trauma • Back/Flank • Risk of retroperitoneal injury • Intraperitoneal organ injury 15-40% • Difficulty evaluating retroperitoneal organs with exam and FAST • In stable pts, CT scan is reliable for excluding significant injury: Biffl et al. 1. ABDOMINAL VASCULAR INJURIES. Ultrasonography (performed by means of a four‐quadrant, focused assessment of sonography for trauma (FAST)) is regarded as a key instrument for the initial assessment of patients with suspected blunt abdominal and thoraco‐abdominal trauma in the emergency department setting. The most important risk after trauma is hypovolemic shock. 2. Apr 19, 2019 · Currently a positive FAST for hemoperitoneum in a hemodynamically unstable patient after penetrating abdominal trauma is a clear indication for emergent laparotomy. All patients sustaining either blunt or penetrating abdominal trauma are at risk for hemorrhage from multiple sites, including the viscera (especially from blunt trauma), the mesentery (from blunt or penetrating trauma), or blood vessels (especially Dec 15, 2021 · abdominal trauma is trauma to the abdomen causing visceral damage and hemorrhage penetrating abdominal trauma divided into two mechanisms start with FAST Apr 28, 2017 · In penetrating abdominal trauma, the reported sensitivity of FAST ranges from 28. Emergent Management of Trauma. The called extended FAST (e-FAST) protocol also searches the pleural spaces for hemothorax and pneumothorax. The primary objective of focused abdominal sonography in trauma (FAST) is to identify the presence of haemoperitoneum in a patient with suspected intra-abdominal injury. A positive FAST is a strong predictor of injury, and patients should proceed directly to laparotomy. patients with blunt abdominal trauma, when complimented by DPL may helps in defining the organ injury. Key words: Blunt Abdominal Trauma, Diagnostic Peritoneal lavage, DPL. The FAST results from 2016 to 2020 were retrospectively reviewed. 1990; 70:671–6. Penetrating Abdominal Injury and is often beneficial over CT for many reasons. The procedure is a diagnostic as well as a therapeutic technique following abdominal trauma or inflammation. Through careful selection of patients, large trauma centers showed good results in the conservative treatment of blunt abdominal trauma presenting with hemodynamic stability and solid organ damage, without injury to hollow viscera. Laparoscopy is sufficient to exclude occult diaphragm injury after penetrating abdominal trauma. Abdominal paracentesis for blood in the setting of penetrating abdominal trauma was described by Shaftan in the 1960s [2]. Abdominal trauma can be broadly classified into: Blunt ; Penetrating; Both of these have different approach of management. 4% incidence of cardiac injury in patients with penetrating chest May 22, 2023 · Intestinal trauma can result from blunt or penetrating abdominal injuries and can cause a wide range of injuries from intestinal bruising to intestinal necrosis. Am Surgeon 63: 669-674: III: Evaluation of focused abdominal sonography for trauma (FAST) following PE in 518 patients (92. The management of penetrating abdominal trauma has evolved greatly over the last century. In this chapter, we focus on the evaluation and management of penetrating abdominal trauma. Results A proposed management guideline for patients with penetrating abdominal trauma was created Jan 6, 2019 · Length of time spent in the emergency department has been shown to correlate with mortality in hypotensive trauma patients requiring laparotomy and in those with a positive FAST exam. INTRODUCTION The car e of the tr aum a pat ien t i s d em andi ng and re qui re s speed and efficiency. In Europe, the majority of abdominal traumas results from a blunt mechanism, whereas penetrating lesions are less frequent. (See "Emergency ultrasound in adults with abdominal and thoracic trauma", section on 'Clinical studies'. Jan 23, 2019 · This has also been described in other studies. Jul 20, 2023 · Traumatic injuries to the abdomen can result from a wide range of etiologies and can lead to life-threatening injuries, multi-organ system dysfunction, and death. Thomas J. 9 Penetrating abdominal stab wounds typically involve the liver, small bowel, diaphragm, and colon. • Motor vehicle accidents (MVAS) – Speed of collision – Position of colliding car to each other, – Position of patient in the car, – Seatbelt use, – Extent of car damage (intrusion, wind shield damage, difficulty of extrication, air bag deployment) • With respect to falls, – Height of fall is very important. Patients with penetrating abdominal trauma can be selected for nonoperative management (NOM) in certain civilian trauma centres. Surg Clin North Am. FAST examination 73. Nov 28, 2019 · Abdominal trauma is classified according to mechanism, either blunt or penetrating, and each demonstrates different patterns of injury that dictate pathways for evaluation and management. Identification of serious intra-abdominal pathology is often challenging; many injuries may not manifest during the initial assessment and treatment period. com Objectives: To assess and compare the diagnostic accuracy of Diagnostic Peritoneal Lavage (DPL) and Focused Assessment Sonography for Trauma (FAST). Its primary utility for penetrating abdominal trauma is to rule out cardiac tamponade (for thoracoabdominal injuries). Udobi KF, Rodriguez A, Chiu WC, Scalea TM. 6% penetrating ). 8 Common mechanisms of injury include stabbings, gun violence, industrial incidents, and explosive injuries. Shah, Essential Emergency Trauma, pgs 143-148; Bailitz J, Bokhari F, Scaletta TA, Schaider J. In penetrating trauma series since then, there has been a large variability in the criteria for a Jan 11, 2016 · This document provides an overview of abdominal trauma, including blunt and penetrating injuries. 1 The types of tests that are needed for Penetrating Abdominal Trauma (Stab Wounds in the Belly) include: - Physical examination - Ultrasound - X-ray - CT scan - Blood tests - Diagnostic Peritoneal Lavage (DPL) - Focused Assessment with Sonography for Trauma (FAST) - Triple contrast CT scan These tests are used to assess the damage, evaluate the extent of the injury, and determine the need for This meta-analysis suggests that laparoscopy is a safe and feasible option in hemodynamic stable patients with blunt abdominal trauma. Trauma is still one of the major causes of death and disability [], and in the case of young people under 40 it is the most significant cause of mortality []. In penetrating abdominal trauma, the reported sensitivity of FAST ranges from 28. . 3% of patients showed no or minor abdominal injury (true-negative or false-positive cases), the value of FAST examinations in cases of blunt trauma with a high-risk Abdominal damage was confirmed in 19. However, they found a sensitivity of only 46%, with an average of 775 mL 3 (range, 150-2000 mL 3 ) of free intraperitoneal blood found during laparotomy in patients with negative FAST results. Semin Pediatr Surg. The optimal test should be rapid, accurate, and non-invasive. Richards JR, McGahan JP. May 21, 2021 · Penetrating abdominal trauma affects approximately 35% of patients admitted to urban trauma centers and 1%–12% of those admitted to suburban or rural centers . Oct 13, 2024 · Focused Assessment with Sonography for Trauma (FAST) scan is a point-of-care ultrasound (POCUS) examination performed at the time of presentation of a trauma patient. Oct 19, 2021 · Video 3. Improvements in CT speed and resolution have allowed for reliable evaluation of both the peritoneum and retroperitoneum. 2001 Mar. g. Feb 16, 2016 · Abdominal paracentesis in the setting of penetrating abdominal trauma was described by Shaftan in the 1960s. Stab wounds (SW) are more common than gunshot wounds (GSW) SW have a lower mortality due to the lower energy transmitted. Management guidelines for penetrating abdominal trauma Jun 3, 2023 · Introduction. mp keyword” (12, 447 hits) You combine the findings from search strategy #1 and #2 (738 hits). The meaning of the acronym was changed to Focused Assessment with Sonography for Trauma (FAST) a year later to reflect applications outside the abdomen. Failure to recognize and properly treat intestinal trauma can result in significant morbidity Nov 3, 2020 · Most commonly injured organ in penetrating abdominal trauma; Abdominal pain, localized tenderness (RUQ) Possible hemorrhagic shock; CT abdomen with IV contrast is the investigation of choice (liver injuries are graded I to VI according to severity) Management. Eighth, the decision to perform additional abdominal CT after FAST was based on the (trauma) surgeon’s clinical judgment, for which no clear criteria could be defined. 3% NPV and 96. • Blunt injury is relatively uncommon. Look for signs of penetrating trauma, burns, ecchymosis (Grey-Turner, Cullen’s sign), foreign bodies (do not remove until sure it is not penetrating a vessel), open fractures, etc. Abdominal surgery after traumatic injury is Mar 21, 2023 · FAST has replaced DPL DPL Washing out of the peritoneal cavity. Usually these injuries occur anterior to the posterior axillary line. Role of laparoscopy in penetrating abdominal trauma: a systematic review. Chest Trauma (CDEM 2019) Penetrating Thoracic Trauma. Blunt abdominal Sep 23, 2020 · Unfortunately, the number of cases was too low to statistically compare the outcome of children to that of adults with a false-negative FAST. 50(3):475-9. Penetrating abdominal injury is uncommon in paediatrics outside of conflict regions, with penetrating trauma of all kinds making up just 1% of children with severe injury in England and Wales in 2017 11; however, conflict Although quantifying the death rate for penetrating abdominal trauma by race is difficult, the relative risk of death for penetrating injury in general is known. Posterior abdominal stab wounds. In penetrating abdominal trauma FAST selects for patients requiring emergent exploratory laparotomy (5). • Abnormal FAST • Abnormal chest or pelvic x-ray • ALT >125 U/L; AST>200 U/L • Decreased Hemoglobin (less than 7g/dl) • Elevated Lipase • Hematuria (UA >50 rbc/hpf) Exclusion criteria: Blunt Abdominal Trauma with peritonitis and penetrating abdominal trauma Manage per surgeon discretion YES YES YES Discharge Home from ED if: 1 [1], [2] Specific indications include penetrating and blunt trauma to the chest, abdominal, and pelvic cavities. Focused Assessment Sonography for Trauma (FAST). Learning Bite Unrecognised abdominal injury remains a significant cause of death. If patients have evisceration, shock due to penetrating abdominal trauma, or peritonitis, do exploratory laparotomy without delay for diagnostic testing. Jan 24, 2019 · This has also been described in other studies. A CT buys you info on what to expect, but your job is still to rule out the bowel injury, diaphragm injury, etc FAST performance in this population was similar to that reported in the context of paediatric blunt trauma, with high specificity for intra-abdominal free fluid. Feliciano, in Current Therapy of Trauma and Surgical Critical Care, 2008 EPIDEMIOLOGY. Blunt abdominal trauma with MESH headings “wounds, non-penetrating”, “abdominal injuries”, “multiple trauma”, and “blunt abdominal trauma. Aug 6, 2024 · Blunt abdominal trauma (see the image below) is a leading cause of morbidity and mortality among all age groups. Friese RS, Coln CE, Gentilello LM. ihwwc wrbprf zucb tsunhqeq cisrlx sjjrkk kvjqzs yroodx svcpnxy chz