MedBalans

First-line therapy

Focused Assessment with Sonography for Trauma • procedure

Duration: Bedside · FAST at bedside — free fluid in peritoneal spaces; unstable + positive FAST → OR; stable + positive → CT and surgery consult (ATLS pediatric)

• **Handle gently:** single careful abdominal exam — repeated aggressive palpation may worsen bleeding; document tenderness, guarding, distension, seatbelt sign, flank ecchymosis (ATLS pediatric).
• **FAST:** bedside ultrasound — free fluid in Morison pouch, splenorenal, pelvis; positive FAST in unstable patient → emergent laparotomy; negative FAST does NOT exclude injury (ATLS).

• **Hemodynamically unstable:** fluid resuscitation per ATLS (crystalloid then blood); emergent laparotomy for peritonitis, evisceration, or persistent instability after initial resuscitation (ATLS, ERC).
• **Hemodynamically stable:** serial abdominal exams; CT with IV contrast when mechanism warrants; non-operative management (NOM) for isolated solid organ injury — bed rest, serial Hgb, activity restriction per trauma surgery (ATLS, AAP).
• **NPO:** all significant abdominal trauma — NG tube if vomiting or distension; no oral intake until cleared by surgery (ATLS).

Urgent laparotomy + trauma surgery • procedure

Duration: ED / inpatient · Emergent operative exploration for hemodynamic instability despite resuscitation, peritonitis, evisceration, free air, or positive FAST in unstable patient (ATLS, pediatric trauma surgery)

• **Laparotomy indications (immediate):** hemodynamic instability with positive FAST or peritonitis; evisceration; free air on imaging; clinical deterioration on serial exam (ATLS).
• **Hollow viscus injury suspicion:** seatbelt sign, handlebar injury, diffuse peritonitis, free air — do NOT rely on NOM; early surgical exploration (ATLS, AAP).
• **Solid organ NOM failure:** transfusion requirement exceeding institutional thresholds, hemodynamic instability after initial stabilization, or pseudoaneurysm on CT — angioembolization or surgery per trauma team (ATLS).
• **Antibiotics:** NOT routine for closed blunt abdominal trauma without perforation — reserve for penetrating variant or established peritonitis (ATLS).
• **Admission:** all significant blunt abdominal trauma — serial exams, Hgb q6–8 h initially, bed rest, NPO; PICU if unstable (ATLS, WHO).

Clinical notes

• Handle abdomen gently: one careful exam — seatbelt sign, handlebar injury, and lap belt marks predict hollow viscus injury (ATLS pediatric).

• FAST in unstable patient: positive → laparotomy; negative but unstable → reassess, repeat FAST, or diagnostic peritoneal tap per protocol (ATLS).
• Stable solid organ injury: non-operative management standard for isolated spleen/liver injury — serial monitoring, transfusion thresholds per trauma surgery (ATLS, AAP).
• Cross-reference crush_injury: abdominal compartment syndrome and concurrent crush syndrome — coordinate fluid resuscitation and renal monitoring (ATLS, WHO).
• Primary care role: recognize peritonitis and instability, IV access, NPO, urgent transport — do not attempt definitive management in primary care (ATLS, WHO Pocket Book).

Abdominal Trauma

First-line therapy

Clinical notes