Download Epigastric Stab Wounds

Epigastric Stab Wounds
An 11-year old male is brought to the
ER 30 minutes after sustaining a stab
wound at the epigastric area during a
street rumble.
Epigastric Stab Wounds
At the Emergency Room:
• He is conversant, conscious, coherent, ambulatory, not in
respiratory distress
• VS: BP 100/60, PR 82 bpm, RR 24 cpm, T 36.5 C
• Pale palpebral conjunctivae, anicteric sclerae
• Chest: symmetrical chest expansion with clear breath sounds
• Heart: normal
• Abdomen: flat, with a 1.5 x 1.5 cm stab wound at the epigastric
area, hypoactive bowel sounds, soft, direct tenderness at the
epigastric area
• Rectal exam is unremarkable
Presentation
• Assessment begins at the scene of the incident and on
the way to the emergency department
• ABC’s of primary survey should be followed
• Upon arrival at the emergency department, incident
history and the patient’s vital is important
• Patients who present with hypotension are already in
class III shock (30-40% blood volume loss), and they
should receive blood products as soon as possible
• Physical examination includes inspection of all body
surfaces, with notation of all penetrating wounds
Presentation
• In the examination of the abdomen, if there is
peritoneal signs, such as pain and guarding and
rebound tenderness, exploration without delay is a
necessity
• Presence of abdominal rigidity or gross abdominal
distention is an indication for prompt surgical
exploration
• Rectal examination, as blood per rectum and highriding prostate can indicate bowel injury and
genitourinary tract injury, respectively
• Notation of blood at the urethral meatus is also a sign
of genitourinary tract injury
Management of penetrating abdominal trauma. CT = computed tomography; DPL =
diagnostic peritoneal lavage; RBC = red blood cells.
Laboratory Studies
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Complete blood count (CBC)
Basic chemistry profile (BMP)
Coagulation studies (PT/INR + PTT)
Arterial blood gas (ABG)
Urine dipstick
Blood Typing and Crossmatching
Ethanol and drug screens
Imaging Studies
• Plain radiograph
• Ultrasound
• CT Scan
Diagnosis
Nasogastric intubation
- All patients undergoing endotracheal
intubation require decompression of the
stomach to decrease the risk of aspiration.
Blood in the nasogastric tube can indicate
upper gastrointestinal injury.
Diagnosis
Foley catheterization
- required to monitor the fluid resuscitation
status of the patient with penetrating
abdominal trauma. The presence of blood in
the urine is a sign of genitourinary tract injury
Diagnosis
Diagnostic peritoneal lavage
- DPL sensitivity for detecting intraabdominal
injury exceeds 95 %
- Results of DPL:
– grossly (+) – if >10 mL of free blood can be aspirated
– if < 10 mL – a liter of normal saline is instilled and the
effluent is sent to the laboratory for RBC count,
amylase alkaline phosphatase, and bilirubin levels and
red blood cell count greater than 100,000/μL is
considered positive
Diagnosis
CT Scan
– specificity for hepatic, splenic, and renal injuries
– indicated primarily for hemodynamically stable
patients who are candidates for nonoperative
therapy