A patient cam e with lower chest trauma with pain in abdomen. His BP is 60/40 pulse 120 next best investigation -
Ans. is 'b' i.e., USG FAST o The prime aim of investigations in a pt. of blunt trauma abdomen is to determine whether the patient needs an exploratory laparotomy or not.o Previously DPL (Diagnostic Peritoneal Lavage) was the inv. of choice to determine the presence of intra-abdominal hemorrhage, but currently L'ltrasound has replaced DPL.o USG is the investigation of choice in both stable as well as unstable patients."Blunt abdominal trauma initially is evaluated by FAST examination in most major trauma centers, and this has largely supplanted DPL. FAST is not 100% sensitive, however, so diagnostic peritoneal aspiration is still advocated in hemodynamically unstable patients without a defined source of blood loss to rule out abdominal hemorrhage. Patients with fluid on FAST examination, considered a 'positive FAST, who do not have immediate indications for laparotomy and are hemodynamically stable undergo CT scanning to quantify their injurie" Schwartz"Hemodynamically stable patients sustaining blunt trauma are adequately evaluated by abdominal ultrasound or CT unless other severe injuries take priority and the patient needs to go to the operating room before the objective abdominal evaluation. In such instances, DPL or focussed abdominal sonography for trauma (FAST) is usually performed in the operating room to rule out intra-abdominal bleeding requiring immediate surgical exploration SabistonAlso knowo Use of USG in trauma pts. is now k/a FAST examination (i.e. Focussed Assessment writh Sonography fora Trauma)# In this examination the goal is not to evaluate the whole abdomen but to look for free intraperitoneal fluid at specific sites.o The diagnostic approach in penetrating abdominal injuries (i.e. stab wounds & Gunshot wounds) differs from that in blunt injuries.o In Gun shot wounds (GSW)# Exploratory laprotomy is mandatory; as chances of internal injury? are high (-90%) in GSWs to abdomeno In stab wounds (SW) In contrast to GSW, SWs that penetrate the peritoneal cavity are less likely to injure intra-abdominal organs.SWs should be explored under local anesthesia in the emergency department whether the peritoneum has been violated.Injuries that do not epnetrate the peritoneal cavity> do not require further evaluation.DPI can also be done to detect intraperitoneal injuries.
CT abdomen
USG FAST
MR .Angiography
X-ray abdomen
Initial Assessment