Pearls and Pitfalls
Patients suffering a high-energy trauma have solid viscera rupture in the abdomen and/or aortic rupture in the thorax until proven otherwise.
Initial abdominal examination is inaccurate for detecting visceral injury, and especially so if the patient is in an altered mental state (alcohol, drugs, closed head trauma), pregnant, or paralyzed.
Significant blunt abdominal trauma alone represents an indication for abdominal imaging.
Fracture of the lower ribs (“abdominal ribs”) should raise a very high suspicion of intra-abdominal injury.
Do not forget the possibility of hollow organ injury, especially with deceleration forces or a potential seat belt injury.
An “elevated” left hemidiaphragm or a left “hydro/hemothorax” must raise the possibility of diaphragmatic rupture.
The ultrasonographic focused abdominal sonography for trauma (FAST) exam has replaced virtually the diagnostic peritoneal lavage because of its ease, speed, sensitivity, and ability to be repeated easily.
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Ferrada, R., Rivera, D., Ferrada, P. (2009). Blunt Abdominal Trauma. In: Bland, K.I., Büchler, M.W., Csendes, A., Sarr, M.G., Garden, O.J., Wong, J. (eds) General Surgery. Springer, London. https://doi.org/10.1007/978-1-84628-833-3_9
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