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Questions and Answers
What is the recommended management for hemodynamically unstable trauma patients with a positive FAST?
What is the recommended management for hemodynamically unstable trauma patients with a positive FAST?
- Immediate exploratory laparotomy (correct)
- Transfer to a surgical facility
- Wait for further diagnostic tests
- Non-operative management
What imaging modality is available at Role 3 facilities to assist in decision making for blunt abdominal trauma?
What imaging modality is available at Role 3 facilities to assist in decision making for blunt abdominal trauma?
- Ultrasound
- MRI
- CT scan (correct)
- X-ray
What is the recommended management for grade IV-V splenic injuries?
What is the recommended management for grade IV-V splenic injuries?
- Splenectomy (correct)
- Non-operative management
- Embolization
- Laparotomy
What is the recommended management for stable grade III splenic injuries without active extravasation, pseudo aneurysm, hemoperitoneum on CT scan or other indications for laparotomy?
What is the recommended management for stable grade III splenic injuries without active extravasation, pseudo aneurysm, hemoperitoneum on CT scan or other indications for laparotomy?
What should be done for patients with a positive FAST and/or evidence of hemoperitoneum through CT at a surgical facility?
What should be done for patients with a positive FAST and/or evidence of hemoperitoneum through CT at a surgical facility?
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Study Notes
- Blunt Abdominal Trauma (BAT) is a diagnostic and clinical challenge.
- CT scans are available at Role 3 facilities to assist in decision making.
- Providers at far forward surgical units must rely on physical assessment and FAST exam.
- Hemodynamically unstable trauma patients with a positive FAST should undergo exploratory laparotomy immediately.
- Patients with positive FAST and/or CT scan may be managed non-operatively if at a Role 3 facility with adequate clinical follow-up.
- Patients with a positive FAST and/or evidence of hemoperitoneum through CT at a surgical facility should not be transferred until ongoing intra-abdominal hemorrhage is controlled.
- Splenic injury grading is presented in Table 1.
- All grade IV-V splenic injuries should undergo splenectomy.
- Non-operative management may be attempted for stable grade III splenic injuries without active extravasation, pseudo aneurysm, hemoperitoneum on CT scan or other indications for laparotomy.
- In Role 3 facilities with interventional radiology capabilities, embolization of grade III splenic injuries may be considered as an adjunct to non-operative management.
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