Blunt Abdominal Trauma

In this post, I would like to be more direct on my medical knowledge. I have posted about everyday topics, which are important, but I am first and foremost a surgeon, willing to share my advice and knowledge on various topics!

Today’s topic is on Blunt Abdominal Trauma.

Blunt abdominal trauma represents a real emergency and requires immediate surgical attention. It is important to get the diagnosis right and to manage the patient from the very beginning in the correct manner so that the outcome is satisfactory. An experienced surgeon is required, especially as unnecessary complications, disabilities and even death can often be avoided if the right treatment regime is initiated.

Noting down the patient’s history, observations and using clinical skills during examinations are of great importance in order to progress efficiently with diagnostic and treatment efforts. Imaging techniques can be a significant part of determining the true extent of the patient’s condition. Some of these include sonography, radiological examinations and CT scans and need to be available without delay.  It is wise to then begin with close monitoring in an intensive care setting, in order to register any abnormalities and changes within the patient’s condition. In addition to monitoring your patient, laboratory facilities, infusion fluids and blood transfusions must be available and accessible.

The most common traumata are haematomata within the abdominal wall or retroperitoneal haematomas and bleedings. Intra-abdominal injuries must always be considered, as splenic, liver injuries or tears to the bowel, mesentery, omentum, bladder, diaphragm, pancreas or other abdominal structures. Significant blood loss of more than 1 liter always requires immediate compensation by fluid resuscitation via an efficient venous access or by uncross-matched or cross-matched blood, if there is enough time. Ongoing and life threatening bleeds require immediate intervention either by compression or endovascular occlusion or surgical intervention. In an ideal setting the trauma surgeon should have an inter-ventional radiologist or vascular surgeon on standby. Not only will the quality of the surgical skill and management be a lot higher, as the likelihood of various difficulties and issues increases, the need for more staff is imminent. An emergency theatre and anaesthetic staff also need to be available for treatment without significant delay once an indication for surgical intervention is made. This can happen within the initial phase of the patient’s assessment or at a later stage (ranging from hours – days). Sometimes it can be extremely difficult to diagnose dangerous and life threatening bowel injuries, which might not be picked up by imaging techniques including ultrasound or CT scans. But  if these injuries are missed, patients can develop sepsis and even die.

Blunt abdominal trauma therefore requires extra resources personal, equipment and facilities as well as specially trained and experienced surgeons to achieve a good outcome. When the right decision is made and the process is followed, the results can be very awarding, as it can mean the difference between life and death. A good outcome without disabilities is caused by excellent and active interference of manageable complications.

And with that, enjoy your weekend young surgeons!

– Clemens

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