(OPERATIVE v/s CONSERVATIVE MANAGEMENT) Dr.Anil Haripriya

10. The classical ‘seatbelt’ sign. The bruising on the left breast is from the shoulder belt and the low bruising to the abdominal wall is from the lapbelt.

12. DIAGNOSTIC STRATEGY INVESTIGATIONS – Aim To identify To decide When (those with injury) (which ones (how quickly need laparotomy) this must be undertaken)

23. TABLE Diagnostic Modalities in Abdominal Trauma PERITONEAL LAVAGE ULTRASOUND CT SCAN Use Records intra-abdominal haemorrhage in stable/unstable trauma Reveals intra-abdominal haemorrhage in stable and unstable in patients Reveals organ of injury and extent of blunt/penetrating abdominal trauma in stable patients Contra-indications  Urgent demand for laparotomy  Prior abdominal surgery  Pregnancy and obesity  Urgent demand for laparotomy  Obesity and subcutaneous emphysema  Need for emergency laparotomy in an unstable patient  Unco-operative patients  Allergy to contrast material Drawback Unreliable in retroperitoneal and diaphragmatic trauma Failes to show small amount of fluid  Unreliable in detection of rupture of bowel and diaphragmatic injuries  Time consuming  High cost

24. TABLE Diagnostic Modalities in Abdominal Trauma cont….. * Gruessner B, Mentges B, Duber C, et al : Sonography versus peritoneal lavage in blunt abdominal trauma. J Trauma 29:242, 1999. ** Meyer D M, Thal E R, Weigelt J A, et al: The role of abdominal CT in the evaluation of stab wounds to the back. J Trauma 29:1226, 1999. PERI-TONEAL LAVAGE ULTRA-SOUND CT SCAN Sensitivity 100%  84%  89%** Specificity 97%  88%  98%** Accuracy 99%  86%  97% 

35. PROTOCOL FOR BLUNT TRAUMA ABDOMEN MANAGEMENT

38. Temporary closure of the abdomen using two Opsite sheets.

41. THANK YOU