Algorithm: Management of small bowel injury Open full size image Must-Know Essentials: Management of Small Bowel Injuries Anatomy of Small Bowel ■ Divisions of the small bowel ■ The small bowel is 4–6 meters long and divided into the duodenum, jejunum, and ileum. ■ Duodenum (see Chapter 28 for details) ■ Jejunum ■ Continuation of the fourth part of the duodenum at duodenojejunal flexure situated on…

Algorithm: Management of stomach injury Open full size image Must-Know Essentials: Anatomy of the Stomach Parts of the Stomach ■ Cardia ■ Superior part of the stomach that contains the cardiac sphincter ■ Situated at T11 vertebra level ■ Fundus ■ Part of the stomach superior and left of the cardia ■ Body ■ Largest part of the stomach ■ Antrum ■ Below the body of…

Illustration: Anatomy of spleen Open full size image Algorithm: Management of splenic injury Open full size image Must-Know Essentials: Evaluation and Management of Splenic Injury Anatomy of the Spleen ■ Location ■ Situated under the left diaphragm at the level of ribs 9–11 ■ Important relations ■ Lateral to the stomach ■ Anterosuperior to the left kidney ■ Tail of the pancreas is in proximity to…

Algorithm: Evaluation of pancreas injury Open full size image Algorithm: Management of pancreatic injury Open full size image Must-Know Essentials: Anatomy of the Pancreas Location ■ Retroperitoneum ■ Extends obliquely at the level of L1 and L2 vertebra Division of the Pancreas ■ Head of the Pancreas ■ Located in the C-loop of the duodenum ■ On the right side of the superior mesenteric vessels ■…

Illustration: Liver anatomy Open full size image Must-Know Essentials: Anatomy of the Liver (see illustration of liver anatomy) Ligaments of the Liver ■ Falciform ligament ■ Attaches the anterior surface of the liver to the anterior abdominal wall ■ Free edge of the Falciform ligament contains the remnant of umbilical vein and known as round ligament of the liver. It is also called the ligamentum of…

Algorithm: Trauma exploratory laparotomy Open full size image Must-Know Essentials: Principles of Trauma Exploratory Laparotomy Preparation ■ Use broad-spectrum preoperative antibiotics. ■ Type and cross-match for blood. ■ Place a nasogastric tube. ■ Place a Foley catheter. ■ Prepare and drape the chest, abdomen, and both lower extremities up to the knees. Abdominal Incision and Entry of the Abdominal Cavity ■ Make a midline incision from…

Algorithm: Evaluation & management of hemodynamically stable abdominal penetrating/blunt trauma Open full size image Must-Know Essentials: Anatomy of the Abdomen Surface Anatomy ■ External abdomen extends from the diaphragm to the infragluteal fold. ■ Divided into: ■ anterior abdomen ■ posterior abdomen ■ intrathoracic abdomen ■ flank. ■ Anterior abdomen ■ Extension ■ Superior: Transverse line through bilateral fourth intercoastal space (nipple level) ■ Inferior: Bilateral…

Algorithm: Management of hemodynamically unstable penetrating abdominal trauma Open full size image Algorithm: Management of hemodynamically unstable blunt abdominal trauma Open full size image Must-Know Essentials: Initial Evaluation and Management Unstable Patient ■ Persistent hypotension: Systolic blood pressure (SBP) <90 mm Hg ■ Transient or no response in blood pressure with crystalloid infusion Initial Management ■ Assessment of the airway ■ Secure a definitive airway. ■…

Algorithm: Evaluation & management of severe thoracic injuries Open full size image Must-Know Essentials: Evaluation of Thoracic Injuries Initial Evaluation and Management ■ Airway ■ Assessment for definitive airway. ■ Endotracheal (ET) intubation/surgical airway if indicated ■ Breathing and Ventilation ■ Chest tube thoracostomy if indicated ■ Mechanical ventilators if indicated ■ Circulation ■ Venous access or intraosseous access ■ Infusion of Crystalloid solution ■ Assessment…

Algorithm: Approaches for emergency thoracotomies Open full size image Must-Know Essentials: Anatomy of the Chest Thoracic Mediastinal Structures (see Illustrations) ■ Ascending aorta ■ Two main coronary arteries originate from the root of the ascending aorta. ■ The left main coronary artery branches into the left anterior descending artery (LAD) and the circumflex artery to supply the left heart. ■ The right coronary artery branches into…

Algorithm: Evaluation & management of penetrating neck injuries Open full size image Must-Know Essentials: Anatomical Zones of Penetrating Neck Injuries Zone 1 ■ Extends between the clavicle and sternal notch inferiorly to a horizontal plane passing through the cricoid cartilage superiorly ■ Structures ■ Proximal common carotid arteries ■ Vertebral and subclavian arteries ■ Subclavian, innominate, and jugular veins ■ Trachea ■ Recurrent laryngeal nerves ■…

Algorithm: Blunt neck injury evaluation & management Open full size image Must-Know Essentials: Evaluation of Blunt Neck Injury Mechanism of Blunt Neck Injuries ■ Motor vehicle collision (MVC) ■ Most common cause ■ Injuries may result from: ■ steering wheel. ■ dashboard. ■ shearing force from shoulder belt. ■ Hanging leading to neck strangulation ■ Punching in the neck ■ Chiropractic excessive manipulation leading to carotid…

Algorithm: Evaluation of spinal cord injuries Open full size image Must-Know Essentials: Etiology and Mechanism of Spinal Cord Injury Incidence of Spinal Cord Injury (SCI) ■ Cervical 50% ■ Thoracic 35% ■ Lumbar 11% Etiology ■ Trauma accounts for more than 90% of spinal cord injuries. ■ Causes include: ■ motor vehicle collision (MVC). ■ fall. ■ sports injuries. ■ penetrating injuries. Mechanism of SCI ■…

Algorithm: Management of thoracic & lumbar spine injuries Open full size image Must-Know Essentials: Evaluation of Thoracolumbar Spine Injuries Initial Evaluation ■ Primary survey and resuscitation ■ Airway ■ Protect the C-spine ■ Protection of thoracolumbar spine in suspected injury ■ Breathing ■ Circulation ■ Rule out life-threatening injuries. Evaluation of Fracture ■ Clinical ■ Back pain ■ Spine tenderness ■ Step-off deformity ■ Neurological evaluation…

Algorithm: Evaluation and Management of Cervical Spine Injuries Open full size image Must-Know Essentials: Evaluation of Cervical Spine Injury Initial Evaluation ■ Primary survey and resuscitation ■ Airway ■ Protect the C-spine ■ Breathing ■ Circulation ■ Rule out life-threatening injuries. Evaluation of Fracture ■ Clinical ■ Neck pain ■ C-spine tenderness ■ Imaging ■ Plain film ■ Anteroposterior (AP) view, lateral view (must include C7–T1),…

Algorithm: Cervical spine clearance Open full size image Must-Know Essentials: Cervical Spine Clearance You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Algorithm: Scalp laceration, skull Fractures, and facial fractures Open full size image Must-Know Essentials: Evaluation of Skull and Maxillofacial Injuries Airway and C-spine Protection ■ Complex skull and facial injuries are usually complicated by a compromised airway. ■ Contributing factors ■ Head injury with diminished level of consciousness ■ Alcohol, and/or drug intoxication ■ High risk of aspiration ■ Presence of broken teeth, dentures, foreign bodies,…

Algorithm: Management of severe head injury Open full size image Must-Know Essentials: Physiology of Cerebral Perfusion Volume-Pressure Curve (Monro-Kellie Hypothesis) ■ Skull is a rigid compartment and contains three components: ■ Brain ■ Blood ■ Cerebrospinal fluid (CSF) ■ Average adult skull contains a total volume of 1475 mL: ■ Brain: 1300 mL ■ CSF: 65 mL ■ Arterial and venous blood: 110 mL ■ An…

Algorithm: Evaluation of head injury Open full size image Must-Know Essentials: Evaluation of Head Injury Glasgow Coma Scale (GCS) ■ Best eye-opening response Score ■ Spontaneous 4 ■ To speech 3 ■ To pain 2 ■ None 1 ■ Best verbal response ■ Oriented 5 ■ Confused conversation 4 ■ Inappropriate words 3 ■ Incomprehensible 2 ■ None 1 ■ Best motor response ■ Obeys commands…

Algorithm: Monitoring of resuscitation of hemorrhagic shock Open full size image Must-Know Essentials: Monitoring of Resuscitation and Endpoint of Resuscitation Background ■ Multiple hemodynamic, metabolic, and regional parameters are available to monitor the resuscitation of shock in trauma patients. ■ No single hemodynamic or laboratory parameter can be used to define the endpoint of resuscitation. ■ Traditional monitoring parameters are proven to be poor indicators of…