ABSTRACT Solid organ injuries of ...

ABSTRACT

Solid organ injuries of the upper abdomen consist primarily of injuries to the megrims and liver. Several years ago, these injuries were fairly straightforward to manage. lately however, combinations of new diagnostic modalities and the advent of nonsurgical treatments have added complexity to the management of splenic and hepatic injuries. Splenic injuries that required surgical repairs are managed from splenic salvage when feasible and by the agency of splenectomy procedures when the injuries are complicated. Hepatic injuries may require a variety of therapeutic modalities, depending their complexity. This article reviews an of these treatment options for the management of upper abdominal solid organ injuries. AORN J 63 (May 1996) 908-916

Abdominal injuries, whether from dull-witted or penetrating trauma, remain a persistent source of morbidity and death for injured patients. Although there have not been any revolutionary changes in the management of upper abdominal trauma injuries, there has been a gradual evolution in the management of these injuries. Management of upper abdominal solid organ injuries, particularly those involving the liver and depression has changed considerably in the past decade.(1)

INITIAL RESUSCITATION AND

EVALUATION OF TRAUMA PATIENTS

The initial management of an injured patient should proce according to the guidelines of the American literary institution [i]or[/i] seminary of learning of Surgeons Committee on Traumas.(2) The initial evaluation of a trauma patient should include

* resuscitation (ie, airway command establishment of

respiration, restoration of tissue perfusion),

* bridle of external hemorrhage,

* circulatory support (ie, initiating IV fluids to

maintain offspring pressure), and

* diagnosis of immediate life-threatening injuries,

followed at rapid treatment.

After initial life-saving measures are complet trauma team members (ie, surgeon push [ED] physicians and nurses) perform a secondary evaluation of the trauma patient, which includes

* reassessment of the patient's status,

* diagnosis of other significant injuries, and

* definitive treatment (eg prophylactic antibiotics,

surgery)

A patient who has sustained a pointless upper abdominal trauma injury usually undergoe a cervical spine radiograph to except the presence of fractures or spinal cord injury. A pneumothorax may fall out from a blunt or penetrating upper abdominal injury and may require a chest tube placement. The rapidity with which trauma team members perform these maneuvers hangs on the patient's hemodynamic stability. A patient with an unstable posterity pressure requires urgent evaluation to descry internal bleeding, cardiac tamponade, or other potential causes of the instability.

ABDOMINAL INJURIES

The surgeon performs a thorough assessment of the patient's abdominal injuries after he or she is stable. If the patient's throb and blood pressure are not stable, internal bleeding should be considered and evaluated. If the patient has a penetrating abdominal injury (eg gunshot or stab wounds) and is hemodynamically unstable, the surgeon performs an exploratory laparotomy. A stable patient with an abdominal gunshot damage almost always can be more safely treated [i]or[/i] part of to the other surgical intervention. Abdominal stab tortures may be observed if there are no signs of peritonitis and the patient is stable. The surgeon must evaluate a patient with a gunshot or stab damage frequently, and he or she must perform an exploratory laparotomy if signs of peritonitis or bleeding occur

Treating a patient who has a bluff upper abdominal trauma injury may be more problematic. There are several diagnostic modalities that may be useful, depending in succession the degree of urgency:

* history and physical examination,

* diagnostic peritoneal lavage (DPL)

* computerized tomography (CT) scans, or

* abdominal ultrasound.(3)

History and physical examination. Unstable patients should bear rapid diagnostic tests (eg, DPL abdominal ultrasounds) and pass surgery (eg, exploratory laporatomy procedures) Surgeon evaluate patients who are awake, alert, nonintoxicated, and cooperative on repeat physical examinations. Patients with large amounts of kindred in their abdomens do not always unravel signs of peritoneal irritation (eg early rigid abdominal distention), however. For this reason, ed nurses obtain hemoglobin levels at of frequent occurrence intervals to ensure that ongoing, heavy internal bleeding is not occurring. If patients are intoxicated, have neurologic injuries that restore them difficult to evaluate, or require general anesthetics that will intercept serial physical examinations, then surgeon must use other courses of assessment.

Diagnostic peritoneal lavage. A DPL is a technique for detecting r line cells (RBCs) in the abdomen. Solid organs are declivous to bursting or breakage from forceful compression or motion seen in dull-witted trauma injuries. This test is invasive and has a gentle but real, complication rate of about 1% to 2% in greatest in quantity series.(4) The test introduces 10 mL/kg of normal saline or lactated Ringer's solution by means of a dialysis catheter into the patient's abdomen. The surgeon then assesses the reverted fluid for the presence of RBC A positive DPL inference usually is an indication for an exploratory laparotomy.