Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Blunt Abdominal Trauma Medication

  • Author: Eric L Legome, MD; Chief Editor: John Geibel, MD, DSc, MSc, MA  more...
 
Updated: Mar 15, 2016
 

Medication Summary

Judiciously prescribe pain medications to patients who are discharged. To prevent masked or delayed presentations, ensure that a close follow-up for reevaluation is available to all patients who are provided pain medications. With the potential for hemorrhage, nonsteroidal anti-inflammatory drugs (NSAIDs) probably should be avoided. Acetaminophen with or without small quantities of mild narcotic analgesics may be all that should be prescribed initially. Minimize use of analgesics in patients who are admitted for observation.

Patients who undergo laparotomy may require routine perioperative antibiotics. Patients with repaired hollow organ injury may require additional antibiotics.

Next

Analgesics

Class Summary

Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and prevents exacerbations in tachycardia and hypertension.

Morphine sulfate (Duramorph, Astramorph, MS Contin, Avinza, Kadian)

 

Morphine is the drug of choice for narcotic analgesia due to its reliable and predictable effects, safety profile, and ease of reversibility with naloxone. Like fentanyl, morphine sulfate is easily titrated to desired level of pain control.

Morphine sulfate administered intravenously may be dosed in a number of ways. It is commonly titrated until the desired effect is obtained.

Fentanyl citrate (Fentora, Abastral, Duragesic)

 

A synthetic opioid analgesic that is primarily a mu receptor agonist, fentanyl is 50-100 times more potent than morphine. It has a short duration of action (1-2 h) and minimal cardiovascular effects, such as hypotension. Respiratory depression is uncommon, but this effect lasts longer than its analgesic effect. Fentanyl is frequently used in patient-controlled analgesia for relief of pain. Unlike morphine, fentanyl is not commonly associated with histamine release.

Acetaminophen and hydrocodone (Vicodin, Lortab, Norco)

 

This drug combination is indicated for relief of moderate to severe pain.

Hydromorphone (Dilaudid)

 

Hydromorphone is a potent semisynthetic opiate agonist similar in structure to morphine. It is approximately 7-8 times as potent as morphine on mg-to-mg basis, with a shorter or similar duration of action.

Acetaminophen with codeine (Tylenol-3)

 

This combination is a mild narcotic analgesic. Provide the family with a small supply for use when pain severity is greater than can be managed with acetaminophen alone. Counsel parents to use for severe pain only, not as the first medication for each symptom.

Previous
Next

Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Cefazolin

 

Cefazolin is a first-generation semisynthetic cephalosporin, which, by binding to 1 or more penicillin-binding proteins, arrests bacterial cell wall synthesis and inhibits bacterial replication. It has a poor capacity to cross the blood-brain barrier. Cefazolin is primarily active against skin flora, including S aureus. Regimens for intravenous and intramuscular dosing are similar. It is typically used alone for skin and skin-structure coverage.

Cephalexin (Keflex)

 

This is a first-generation cephalosporin that inhibits bacterial replication by inhibiting bacterial cell wall synthesis. It is bactericidal and is effective against rapidly growing organisms forming cell walls.

Resistance occurs by the alteration of penicillin-binding proteins. Cephalexin is effective for treatment of infections caused by streptococcal or staphylococcal organisms, including penicillinase-producing staphylococci. It may use to initiate therapy when streptococcal or staphylococcal infection is suspected.

It is used orally when outpatient management is indicated.

Cefotaxime (Claforan)

 

Cefotaxime is a third-generation cephalosporin with a broad gram-negative spectrum, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms. It acts by arresting bacterial cell wall synthesis by binding to one or more penicillin-binding proteins, which, in turn, inhibits bacterial growth. Cefotaxime is used for septicemia and treatment of gynecologic infections caused by susceptible organisms, but it has a lower efficacy against gram-positive organisms.

Ceftazidime (Fortaz, Tazicef)

 

Ceftazidime is a third-generation cephalosporin with broad-spectrum, gram-negative activity, including against Pseudomonas; it has low efficacy against gram-positive organisms and high efficacy against resistant organisms. This agent arrests bacterial growth by binding to one or more penicillin-binding proteins, which, in turn, inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall synthesis, thus inhibiting cell wall biosynthesis.

The condition of the patient, severity of infection, and susceptibility of the microorganism should determine the proper dose and route of administration.

Ceftriaxone (Rocephin)

 

Ceftriaxone is a third-generation cephalosporin with broad-spectrum gram-negative activity, low efficacy against gram-positive organisms, and high efficacy against resistant organisms. It is considered the drug of choice for parenteral agents in community-acquired pneumonia. Bactericidal activity results from the inhibition of cell wall synthesis by binding to one or more penicillin-binding proteins. This agent exerts its antimicrobial effect by interfering with the synthesis of peptidoglycan, a major structural component of the bacterial cell wall. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes, while the cell wall assembly is arrested.

Ceftriaxone is highly stable in the presence of beta-lactamases, both penicillinase and cephalosporinase, and of gram-negative and gram-positive bacteria. Approximately 33-67% of the dose is excreted unchanged in urine, and the remainder is secreted in bile and, ultimately, in feces as microbiologically inactive compounds. This agent reversibly binds to human plasma proteins, and binding has been reported to decrease from 95% bound at plasma concentrations of less than 25 mcg/mL to 85% bound at 300 mcg/mL.

Erythromycin (E.E.S., Ery-Tab, Erythrocin, PCE, EryPed)

 

Erythromycin covers most potential etiologic agents, including Mycoplasma species. The oral regimen may be insufficient to adequately treat Legionella species, and this agent is less active against H influenzae. Although the standard course of treatment is 10 days, treatment until the patient has been afebrile for 3-5 days seems a more rational approach. Erythromycin therapy may result in GI upset, causing some clinicians to prescribe an alternative macrolide or change to a thrice-daily dosing.

Erythromycin is a macrolide that inhibits bacterial growth possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Amoxicillin and clavulanate (Augmentin, Augmentin XR, Amoclan)

 

Amoxicillin inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. The addition of clavulanate inhibits beta-lactamase producing bacteria.

It is a good alternative antibiotic for patients allergic to or intolerant of the macrolide class. It is usually is well tolerated and provides good coverage to most infectious agents. It is not effective against Mycoplasma and Legionella species. The half-life of the oral dosage form is 1-1.3 hours. It has good tissue penetration but does not enter cerebrospinal fluid.

For children older than 3 months, base the dosing protocol on the amoxicillin content. Due to different amoxicillin/clavulanic acid ratios in the 250-mg tablet (250/125) versus the 250-mg chewable tablet (250/62.5), do not use the 250-mg tablet until child weighs more than 40 kg.

Ampicillin and sulbactam (Unasyn)

 

This is a drug combination of a beta-lactamase inhibitor with ampicillin. It interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. It is an alternative to amoxicillin when the patient is unable to take medication orally.

It covers skin, enteric flora, and anaerobes. It is not ideal for nosocomial pathogens.

Piperacillin and tazobactam sodium (Zosyn)

 

This is an antipseudomonal penicillin plus a beta-lactamase inhibitor. It inhibits the biosynthesis of cell wall mucopeptide and is effective during the stage of active multiplication.

Ticarcillin and clavulanate (Timentin)

 

It inhibits the biosynthesis of cell wall mucopeptide and is effective during the stage of active growth.

It is an antipseudomonal penicillin plus a beta-lactamase inhibitor that provides coverage against most gram-positives, most gram negatives, and most anaerobes.

Ciprofloxacin (Cipro)

 

Ciprofloxacin is a fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth, by inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic material. Quinolones have broad activity against gram-positive and gram-negative aerobic organisms. It is has no activity against anaerobes. Continue treatment for at least 2 days (7-14 d typical) after signs and symptoms have disappeared.

Levofloxacin (Levaquin)

 

Levofloxacin is rapidly becoming a popular choice in pneumonia; this agent is a fluoroquinolone used to treat community-acquired pneumonia caused by S aureus, S pneumoniae (including penicillin-resistant strains), H influenzae, H parainfluenzae, Klebsiella pneumoniae, M catarrhalis, C pneumoniae, Legionella pneumophila, or M pneumoniae. Fluoroquinolones should be used empirically in patients likely to develop exacerbation due to resistant organisms to other antibiotics.

Levofloxacin is the L stereoisomer of the D/L parent compound ofloxacin, the D form being inactive. It is good monotherapy with extended coverage against Pseudomonas species and excellent activity against pneumococci. Levofloxacin acts by inhibition of DNA gyrase activity. The oral form has a bioavailability that is reportedly 99%.

The 750-mg dose is as well tolerated as the 500-mg dose, and it is more effective. Other fluoroquinolones with activity against S pneumoniae may be useful and include moxifloxacin, gatifloxacin, and gemifloxacin.

Clindamycin (Cleocin, Cleocin Pediatric)

 

Clindamycin is a lincosamide semisynthetic antibiotic produced by 7(S)-chloro-substitution of 7(R)-hydroxyl group of the parent compound lincomycin. It inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. It widely distributes in the body, without penetration of the CNS. It is protein bound and is excreted by the liver and kidneys.

It is available in a parenteral form (ie, clindamycin phosphate) and oral form (ie, clindamycin hydrochloride). Oral clindamycin is absorbed rapidly and almost completely and is not appreciably altered by the presence of food in the stomach. Appropriate serum levels are reached and sustained for at least 6 hours following an oral dose. No significant levels are attained in cerebrospinal fluid. It is also effective against aerobic and anaerobic streptococci (except enterococci).

Previous
 
Contributor Information and Disclosures
Author

Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Professor Clinical, Department of Emergency Medicine, State University of New York Downstate College of Medicine

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, Council of Emergency Medicine Residency Directors, American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Samuel M Keim, MD, MS Professor and Chair, Department of Emergency Medicine, University of Arizona College of Medicine

Samuel M Keim, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Jeffrey P Salomone, MD, FACS, NREMT-P Associate Professor of Surgery, Emory University School of Medicine; Deputy Chief of Surgery, Grady Memorial Hospital

Jeffrey P Salomone, MD, FACS, NREMT-P is a member of the following medical societies: American College of Surgeons, American Medical Association, Medical Association of Georgia, National Association of EMS Physicians, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

John Udeani, MD, FAAEM Assistant Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science, University of California, Los Angeles, David Geffen School of Medicine

John Udeani, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert L Sheridan, MD Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School

Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American College of Surgeons

Disclosure: Received research grant from: Shriners Hospitals for Children; Physical Sciences Inc<br/>Received income in an amount equal to or greater than $250 from: SimQuest Inc -- consultant on burn mapping softwear ($1,500).

Chief Editor

John Geibel, MD, DSc, MSc, MA Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow

John Geibel, MD, DSc, MSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, Society for Surgery of the Alimentary Tract

Disclosure: Received royalty from AMGEN for consulting; Received ownership interest from Ardelyx for consulting.

Additional Contributors

Ernest Dunn, MD Program Director, Surgery Residency, Department of Surgery, Methodist Health System, Dallas

Ernest Dunn, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, Association for Academic Surgery, Society of Critical Care Medicine, Texas Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Sidney R Steinberg, MD, FACS, to the development and writing of a source article.

References
  1. Brasel KJ, Olson CJ, Stafford RE, Johnson TJ. Incidence and significance of free fluid on abdominal computed tomographic scan in blunt trauma. J Trauma. 1998 May. 44(5):889-92. [Medline].

  2. Holmes JF, Offerman SR, Chang CH, Randel BE, Hahn DD, Frankovsky MJ, et al. Performance of helical computed tomography without oral contrast for the detection of gastrointestinal injuries. Ann Emerg Med. 2004 Jan. 43(1):120-8. [Medline].

  3. Christiano JG, Tummers M, Kennedy A. Clinical significance of isolated intraperitoneal fluid on computed tomography in pediatric blunt abdominal trauma. J Pediatr Surg. 2009 Jun. 44(6):1242-8. [Medline].

  4. Shanmuganathan K. Multi-detector row CT imaging of blunt abdominal trauma. Semin Ultrasound CT MR. 2004 Apr. 25(2):180-204. [Medline].

  5. American College of Surgeons Committee on Trauma. Abdominal Trauma. In: ATLS Student Course Manual. 8th. American College of Surgeons; 2008.

  6. Jansen JO, Yule SR, Loudon MA. Investigation of blunt abdominal trauma. BMJ. 2008 Apr 26. 336(7650):938-42. [Medline]. [Full Text].

  7. Cooper A, Barlow B, DiScala C, String D. Mortality and truncal injury: the pediatric perspective. J Pediatr Surg. 1994 Jan. 29(1):33-8. [Medline].

  8. Ong CL, Png DJ, Chan ST. Abdominal trauma--a review. Singapore Med J. 1994 Jun. 35(3):269-70. [Medline].

  9. Powell DC, Bivins BA, Bell RM. Diagnostic peritoneal lavage. Surg Gynecol Obstet. 1982 Aug. 155(2):257-64. [Medline].

  10. Hankin AD, Baren JM. Should the digital rectal examination be a part of the trauma secondary survey?. Ann Emerg Med. 2009 Feb. 53(2):208-12. [Medline].

  11. Enderson BL, Reath DB, Meadors J, Dallas W, DeBoo JM, Maull KI. The tertiary trauma survey: a prospective study of missed injury. J Trauma. 1990 Jun. 30(6):666-9; discussion 669-70. [Medline].

  12. Janjua KJ, Sugrue M, Deane SA. Prospective evaluation of early missed injuries and the role of tertiary trauma survey. J Trauma. 1998 Jun. 44(6):1000-6; discussion 1006-7. [Medline].

  13. Lewis R. Pelvic Radiography Unnecessary in Children if CT Is Planned. Medscape Medical News. Aug 12 2014. [Full Text].

  14. Kwok MY, Yen K, Atabaki S, et al. Sensitivity of Plain Pelvis Radiography in Children With Blunt Torso Trauma. Ann Emerg Med. 2014 Jul 29. [Medline].

  15. Schnüriger B, Inaba K, Barmparas G, Eberle BM, Lustenberger T, Lam L, et al. Serial white blood cell counts in trauma: do they predict a hollow viscus injury?. J Trauma. 2010 Aug. 69(2):302-7. [Medline].

  16. Ritchie AH, Williscroft DM. Elevated liver enzymes as a predictor of liver injury in stable blunt abdominal trauma patients: case report and systematic review of the literature. Can J Rural Med. 2006 Fall. 11(4):283-7. [Medline].

  17. Akhrass R, Yaffe MB, Brandt CP, Reigle M, Fallon WF Jr, Malangoni MA. Pancreatic trauma: a ten-year multi-institutional experience. Am Surg. 1997 Jul. 63(7):598-604. [Medline].

  18. Knudson MM, McAninch JW, Gomez R, Lee P, Stubbs HA. Hematuria as a predictor of abdominal injury after blunt trauma. Am J Surg. 1992 Nov. 164(5):482-5; discussion 485-6. [Medline].

  19. Tso P, Rodriguez A, Cooper C, Militello P, Mirvis S, Badellino MM, et al. Sonography in blunt abdominal trauma: a preliminary progress report. J Trauma. 1992 Jul. 33(1):39-43; discussion 43-4. [Medline].

  20. Kawaguchi S, Toyonaga J, Ikeda K. Five point method: An ultrasonographic quantification formula of intra-abdominal fluid collection. Jpn J Acute Med. 1987;7:993-7.

  21. Tiling T, Boulion B, Schmid A, et al. Ultrasound in blunt abdominothoracic trauma. In: Border JR, ed. Blunt Multiple Trauma: Comprehensive Pathophysiology and Care. New York: Marcel Dekker; 1990:415-33.

  22. Blaivas M, Brannam L, Hawkins M, Lyon M, Sriram K. Bedside emergency ultrasonographic diagnosis of diaphragmatic rupture in blunt abdominal trauma. Am J Emerg Med. 2004 Nov. 22(7):601-4. [Medline].

  23. Branney SW, Moore EE, Cantrill SV, Burch JM, Terry SJ. Ultrasound based key clinical pathway reduces the use of hospital resources for the evaluation of blunt abdominal trauma. J Trauma. 1997 Jun. 42(6):1086-90. [Medline].

  24. Kornezos I, Chatziioannou A, Kokkonouzis I, Nebotakis P, Moschouris H, Yiarmenitis S, et al. Findings and limitations of focused ultrasound as a possible screening test in stable adult patients with blunt abdominal trauma: a Greek study. Eur Radiol. 2010 Jan. 20(1):234-8. [Medline].

  25. Kendall JL, Faragher J, Hewitt GJ, Burcham G, Haukoos JS. Emergency Department Ultrasound Is not a Sensitive Detector of Solid Organ Injury. West J Emerg Med. 2009 Feb. 10(1):1-5. [Medline]. [Full Text].

  26. Rozycki GS, Ochsner MG, Schmidt JA, Frankel HL, Davis TP, Wang D, et al. A prospective study of surgeon-performed ultrasound as the primary adjuvant modality for injured patient assessment. J Trauma. 1995 Sep. 39(3):492-8; discussion 498-500. [Medline].

  27. Chiu WC, Cushing BM, Rodriguez A, Ho SM, Mirvis SE, Shanmuganathan K, et al. Abdominal injuries without hemoperitoneum: a potential limitation of focused abdominal sonography for trauma (FAST). J Trauma. 1997 Apr. 42(4):617-23; discussion 623-5. [Medline].

  28. Matsumoto S, Sekine K, Yamazaki M, Sasao K, Funabiki T, Shimizu M, et al. Predictive value of a flat inferior vena cava on initial computed tomography for hemodynamic deterioration in patients with blunt torso trauma. J Trauma. 2010 Dec. 69(6):1398-402. [Medline].

  29. Holmes JF, Lillis K, Monroe D, Borgialli D, Kerrey BT, Mahajan P, et al. Identifying Children at Very Low Risk of Clinically Important Blunt Abdominal Injuries. Ann Emerg Med. 2013 Jan 29. [Medline].

  30. Mahajan P, Kuppermann N, Tunik M, Yen K, Atabaki SM, Lee LK, et al. Comparison of Clinician Suspicion Versus a Clinical Prediction Rule in Identifying Children at Risk for Intra-abdominal Injuries After Blunt Torso Trauma. Acad Emerg Med. 2015 Sep. 22 (9):1034-41. [Medline].

  31. Benjamin ER, Siboni S, Haltmeier T, Lofthus A, Inaba K, Demetriades D. Negative Finding From Computed Tomography of the Abdomen After Blunt Trauma. JAMA Surg. 2015 Dec 1. 150 (12):1194-5. [Medline].

  32. Fabian TC, Croce MA, Stewart RM, Pritchard FE, Minard G, Kudsk KA. A prospective analysis of diagnostic laparoscopy in trauma. Ann Surg. 1993 May. 217(5):557-64; discussion 564-5. [Medline]. [Full Text].

  33. Ivatury RR, Simon RJ, Weksler B, Bayard V, Stahl WM. Laparoscopy in the evaluation of the intrathoracic abdomen after penetrating injury. J Trauma. 1992 Jul. 33(1):101-8; discussion 109. [Medline].

  34. Ortega AE, Tang E, Froes ET, Asensio JA, Katkhouda N, Demetriades D. Laparoscopic evaluation of penetrating thoracoabdominal traumatic injuries. Surg Endosc. 1996 Jan. 10(1):19-22. [Medline].

  35. Neuhof H, Cohen I. ABDOMINAL PUNCTURE IN THE DIAGNOSIS OF ACUTE INTRAPERITONEAL DISEASE. Ann Surg. 1926 Apr. 83(4):454-62. [Medline]. [Full Text].

  36. ROOT HD, HAUSER CW, MCKINLEY CR, LAFAVE JW, MENDIOLA RP Jr. DIAGNOSTIC PERITONEAL LAVAGE. Surgery. 1965 May. 57:633-7. [Medline].

  37. Liu M, Lee CH, P'eng FK. Prospective comparison of diagnostic peritoneal lavage, computed tomographic scanning, and ultrasonography for the diagnosis of blunt abdominal trauma. J Trauma. 1993 Aug. 35(2):267-70. [Medline].

  38. Cryer HG, Larmon B. Patient care phase: prehospital and resuscitation care. In: Greenfield LJ, Mulholland MW, Oldham KT, Zelenock GB, Lillemoe KD, eds. Surgery: Scientific Principles and Practice. Philadelphia: Lippincott-Raven;. 1997:280-4.

  39. Pryor JP, Pryor RJ, Stafford PW. Initial phase of trauma management and fluid resuscitation. Trauma Reports. 2002;3(3):1-12.

  40. Nirula R, Maier R, Moore E, Sperry J, Gentilello L. Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer's effect on mortality. J Trauma. 2010 Sep. 69(3):595-9; discussion 599-601. [Medline].

  41. Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2007 Oct 17. CD000567. [Medline].

  42. Bunn F, Trivedi D, Ashraf S. Colloid solutions for fluid resuscitation. Cochrane Database Syst Rev. 2008 Jan 23. CD001319. [Medline].

  43. Hauser CJ, Boffard K, Dutton R, Bernard GR, Croce MA, Holcomb JB, et al. Results of the CONTROL trial: efficacy and safety of recombinant activated Factor VII in the management of refractory traumatic hemorrhage. J Trauma. 2010 Sep. 69(3):489-500. [Medline].

  44. Requarth JA, D'agostino RB Jr, Miller PR. Nonoperative Management of Adult Blunt Splenic Injury With and Without Splenic Artery Embolotherapy: A Meta-Analysis. J Trauma. 2011 Oct. 71(4):898-903. [Medline].

  45. Mora MC, Wong KE, Friderici J, Bittner K, Moriarty KP, Patterson LA, et al. Operative vs Nonoperative Management of Pediatric Blunt Pancreatic Trauma: Evaluation of the National Trauma Data Bank. J Am Coll Surg. 2015 Dec 18. [Medline].

  46. Crookes BA, Shackford SR, Gratton J, Khaleel M, Ratliff J, Osler T. "Never be wrong": the morbidity of negative and delayed laparotomies after blunt trauma. J Trauma. 2010 Dec. 69(6):1386-91; discussion 1391-2. [Medline].

  47. Mayglothling JA, Haan JM, Scalea TM. Blunt splenic injuries in the adolescent trauma population: the role of angiography and embolization. J Emerg Med. 2011 Jul. 41(1):21-8. [Medline].

  48. Pommerening MJ, DuBose JJ, Zielinski MD, Phelan HA, Scalea TM, Inaba K, et al. Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy. Surgery. 2014 Aug. 156 (2):431-8. [Medline].

  49. Barone JE. Minimize Time Between Damage Control Laparotomy and Take-Back Operation. Reuters Health Information. Available at http://www.medscape.com/viewarticle/827634. July 02, 2014; Accessed: June 26, 2015.

  50. Boggs W. Routine Urinalysis Not Helpful After Blunt Abdominal Trauma. Medscape Medical News. Available at http://www.medscape.com/viewarticle/812180. Accessed: October 15, 2013.

  51. Olthof DC, Joosse P, van der Vlies CH, de Reijke TM, Goslings JC. Routine urinalysis in patients with a blunt abdominal trauma mechanism is not valuable to detect urogenital injury. Emerg Med J. 2013 Sep 16. [Medline].

 
Previous
Next
 
Blunt abdominal trauma. Normal Morison pouch (ie, no free fluid).
Blunt abdominal trauma. Free fluid in Morison pouch.
Blunt abdominal trauma. Normal splenorenal recess.
Blunt abdominal trauma. Free fluid in splenorenal recess.
Blunt abdominal trauma with splenic injury and hemoperitoneum.
Blunt abdominal trauma with liver laceration.
Blunt abdominal trauma. Right kidney injury with blood in perirenal space. Injury resulted from high-speed motor vehicle collision.
Ultrasound image of right flank. Clear hypoechoic stripe exists between right kidney and liver in Morison pouch.
Ultrasound image of left flank in same patient, with thin hypoechoic stripe above spleen and wider hypoechoic stripe in splenorenal recess.
Surgical cricothyroidotomy Seldinger. Video courtesy of Therese Canares, MD, and Jonathan Valente, MD, Rhode Island Hospital, Brown University.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.