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Trauma Abdominal Cerrado con el Dr. Raphael Parrado
With Dr. Rafael Parrado
Chapter 1 of 6 · Fundamentals
Epidemiology & Assessment
Epidemiology and Initial Assessment of Pediatric Closed Abdominal Trauma
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What the experts said
Closed abdominal trauma accounts for 95% of pediatric trauma cases
The spleen is the most commonly injured organ in pediatric closed abdominal trauma, accounting for 40% of cases
Other organs injured include pancreas, kidney, and intestines
The seatbelt sign on physical examination is an important finding in closed abdominal trauma
Seatbelt sign can be associated with pelvic fractures or, in the absence of pelvic fractures, with pancreatic injuries
Abdominal palpation should assess for signs of peritonitis
FAST ultrasound is the most commonly used study to determine if there is free fluid in the abdomen
Laboratory studies commonly used include renal panel, hematocrit, amylase, and aminotransferases
Amylase greater than 200 or elevated aminotransferases indicate need for CT imaging
PECARN (Pediatric Emergency Care Applied Research Network) provides parameters for CT imaging including Glasgow Coma Scale, abdominal examination findings, and mechanism of trauma
For patients with minor injuries and hemodynamic stability, observation in the emergency department or even discharge home with close follow-up can be appropriate
Non-operative management protocols involve crystalloid fluid resuscitation with monitoring of hemoglobin
Even grade 4 or 5 solid organ injuries can be observed non-operatively in hemodynamically stable patients
Key monitoring parameters during observation include progression of abdominal examination findings and hematuria
Indications for laparotomy include peritonitis, free air, and transfusion requirement of 40 mL/kg or 4 units of packed red blood cells despite resuscitation
Surgical incision for trauma laparotomy extends from xiphoid to pubis
The most common finding requiring surgery is grade 4 or 5 injury, but grade 3 injuries may also require surgery if there is ongoing bleeding
Techniques for hemorrhage control include packing of anterior and posterior abdomen, direct pressure, and use of non-permanent coagulation aids
Non-anatomic resection with stapler can be performed for ongoing bleeding when anatomic resection is not feasible
For diffuse venous bleeding rather than arterial pulsatile bleeding, packing is the most appropriate technique
Damage control approach involves packing and planned re-exploration in 24 hours
For splenic injuries, splenectomy is more practical than attempting splenic salvage in the acute trauma setting
Complications of massive transfusion include coagulopathy and pulmonary edema
Patients require close monitoring in intensive care after damage control surgery
Important complications after non-anatomic resection include peritonitis and infectious complications
Overwhelming post-splenectomy sepsis is a serious and potentially fatal complication
Post-splenectomy patients should receive vaccination approximately 2 weeks after surgery