Re: Intra-abdominal injury

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Posted by ttt from IP on September 10, 2016 at 20:05:26:

In Reply to: Intra-abdominal injury posted by ttt on July 16, 2016 at 23:07:06:

Thank you Drs.
What do you think about the explanation below.

Q: An obviously intoxicated 50-year-old white male is brought to the emergency department after the car he was driving hit a telephone pole. He has a fracture of the femur, and is confused and uncooperative. He is
hemodynamically unstable. Initial physical examination of his abdomen does not indicate significant intra-abdominal injury. Which one of the following would be best for determining whether laparotomy is needed?

A: Peritoneal lavage

Physical examination of the abdomen is often unreliable for detecting significant intra-abdominal injury, especially in the head-injured or intoxicated patient. In a hemodynamically unstable patient with a highrisk
mechanism of injury and altered mental status, peritoneal lavage is the quickest, most reliable modality to determine whether there is a concomitant intra-abdominal injury requiring laparotomy. CT of the abdomen
and contrast duodenography may complement lavage in stable patients with negative or equivocal lavage results, but in an unstable or uncooperative patient these studies are too time-consuming or require ill-
advised sedation. Ultrasonography may also complement lavage in selected patients, but its usefulness is limited in the acute situation.

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