By Harry M. Delany M.D., F.A.C.S., Robert S. Jason M.D. (auth.)
Trauma to the stomach, either unintentional and willful, has develop into more and more universal during this period of accelerating violence. huge numbers of sufferers everywhere in the nation are admitted to emergency rooms as a result of belly trauma of various levels of severity. All too frequently the right kind prognosis is suspected belatedly or by no means, in order that right therapy isn't initiated in adequate time to be lifesaving. no longer infre quently, the injured sufferer is tested through an intern or an insufficiently skilled resident healthcare professional. Even in cases the place extra senior internists and surgeons can be found, distinctive wisdom concerning the valuable technique to set up the proper prognosis and institute the best therapy is missing. This monograph, representing the felicitous collaboration of a medical professional and a radiolo gist including numerous different members, is well timed and critical. The authors (and their members) have approached their topic with a wealth of medical experi ence got in numerous very energetic acute-care municipal hospitals within the greatest urban during this nation. they've got saw and handled a really huge variety of sufferers with a large number of hectic factors, together with firearm accidents, stab wounds, vehicular injuries, falls, and attacks. The authors have divided this paintings into 4 major sections: common views on belly damage, kinds of stomach accidents, particular Diagnostic options, and particular Organ or Supporting-Structure Injury.
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Extra resources for Abdominal Trauma: Surgical and Radiologic Diagnosis
Ancillary diagnostic procedures such as paracentesis with lavage can be of help in such patients (see p. 90 on paracentesis and lavage). If bloody fluid is obtained or if the lavage fluid appears to exit from the chest tube, the presence of diaphragmatic penetration and possible intraabdominal injury should be assumed. The quadrant of injury and the pathway of the wounding agent must be evaluated.
There was no evidence of current or previous parasitic disease. Physical Diagnosis Careful inquiry regarding all medications will sometimes alert the physician to the patient's unique drugrelated vulnerability. Of course, the routine inquiry about allergy and idiosyncratic drug reactions is most important in all medical workups and must not be ignored in the evaluation of the trauma patient. The examining physician can be misled by the history presented by a trauma victim. The "contracoup" injury patient may describe the injuring object as striking one side or area of the body, but the organ injury may be on the opposite side owing to the mobility of some of the intrathoracic and intraabdominal organs.
In addition to the correlation between systems injured and mortality in blunt trauma, there is also some correlation between the number of organs injured and mortality. Of patients who died before admission, 40% had multiple abdominal-organ injuries; of patients alive at the time of admission only 20% had the same findings . The failure to properly diagnose abdominal-organ injury and delayed organ rupture are especially characteristic of the blunt-injury situation. A vigilant diagnostic approach is a prerequisite to the proper management of the blunt-abdominal-trauma patient.