Sunday, August 16, 2009

Penetrating Abdominal Trauma

A good case for discussion with the medical students. This man was apparently stabbed by a knife - looked as if it were quite deep in, as only the knife handle was left visible. A quick ultrasound scan showed that the spleen and kidney on that side (left) were still viable and intact. However, the bowels were floating in free intra-abdominal fluid - the echogenicity suggestive of blood.

Note: has a good description together with pictures on FAST scan (Focused Assessment With Sonography in Trauma). Click here to go.

We had great trouble communicating with him as he could not speak English or Malay language. It is very important to emphasize to students that in the prehospital care/first aid care, that the knife/object in situ should never be removed. Removing such object may:

1. cause further bleeding or re-bleeding if the tip of the knife has hit a vascular structure and tamponading has begun

2. cause further laceration and damage to the underlying structure during its withdrawing track. We never know what is going on inside by pulling the knife blindly. Exploration is needed.

In fact, we may further stabilize the in-situ object should from wobbling with a triangular bandage being folded into the shape of a donut. has another picture as well as an article of such penetrating abdominal injuries. Click here. A excellent e-book on trauma surgery (including penetrating abdominal injuries) is available here. In fact, the entire book is divided into 2 volumes: Vol 1 for non-trauma surgical conditions, and Vol 2 for traumatic surgical conditions. The whole e-book is available for download in pdf in its download page here. Good for both surgical residents and non-surgical residents.

For first aid care resource, I usually refer my students (pre-clinical years) to this site. Short, bulleted notes, with good clear illustrations.


Unknown said...

This patient doesn't need a FAST... he needs to get to the operating table.

cksheng74 said...

Dear Bernard,
I absolutely agree with you that this patient need to get to the OT immediately. FAST was done just as a screening tool - as part of the secondary survey that we perform almost routinely on all trauma patients. I don't think the FAST performed actually delayed substantially the time the patient to OT. This patient was brought to the OT as quick as it can - but even then, it was not as fast as it should be. But that's another story and it is not so appropriate to mention here.

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