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Penetrating Abdominal Trauma
  • Anything below the 4th intercostal space (nipple) is potentially an abdominal injury
    • Gunshot wounds to the abdomen
      • Needs immediate exploratory laparotomy
    • Stab wounds to the abdomen
      • Needs immediate exploratory laparotomy IF…
        • Hemodynamically unstable
        • Peritonitis on exam (rebound, rigidity, guarding)
        • Organs hanging out of abdomen
Blunt Abdominal Trauma
  • If the patient is unstable
    • Perform FAST exam
  • If the patient is stable
    • CT scan of the abdomen/pelvis with contrast
Basilar Skull Fracture
  • Bilateral post-auricular ecchymosis (Battle’s Sign)
  • Raccoon eyes
  • Hemotympanum
  • Otorrhea/Rhinorrhea
Tension Pneumothorax
  • Classic findings
    • Hypotension
    • Obstructive shock
    • Absent breath sounds
    • Jugular vein distension (JVD)
  • Treatment
    • Needle decompression
      • 2nd intercostal space
      • Mid-clavicular line
    • Tube thoracostomy
Hemothorax
  • Hypotension
    • Hemorrhagic shock
  • Absent breath sounds
  • NO jugular vein distension
Cardiac Tamponade
  • Beck’s Triad
    • Hypotension
      • Obstructive shock
    • Jugular vein distension
    • Muffled heart sounds
  • Perform bedside ultrasound
    • Diastolic collapse of right ventricle (RV)
  • EKG
    • Electrical alterans
Traumatic Aortic Rupture
  • Rapid deceleration injuries
  • Tears at ligamentum arteriosum
  • Widened mediastinum on chest X-Ray
Pulmonary Contusion
  • Blunt chest trauma
  • Respiratory distress
    • NO paradoxical chest movement with breathing
  • Chest X-Ray
    • Shows non-lobar infiltrates
    • Located near location of injury
Additional Reading