Push, Pringle, Plug and Pack is used for:
Ans. (a) LiverRef: Bailey and Love 27th edition Page 374* MC organ injured in Blunt trauma- Spleen* MC organ injured in Penetrating Trauma - Liver > Small IntestineManagement of Liver Trauma:The management of Liver trauma is given by 4 P's* Push*Pringle* Plug* PackPush: During laparotomy Lacerated liver is brought back and Bimanual compression done to achieve the normal structurePringle: Inflow occlusion is done for Hepatic artery and portal vein via the Epiploic foramen, it will stop the inflow, but yet there may be bleeding by back flow from IVC to Hepatic vein.Plug: Any holes in penetrating area is plugged with Silicone tube or Sengstaken Blakemore tube.Packing: Complete packing of the liver is all sides is done after all the above using pads which can be removed after 24-48 hours.Other important points in Liver trauma management:* Bleeding points can be sutured or angio embolised.* No need to suture the penetrating injuries of liver.* If there is a damage of Hepatic artery it can be tied off.* Portal vein must not be tied and should be repaired or else there is 50% mortality.* If Portal Vein is difficult to repair it should be stented and referred to higher Institute.* Closed Suction drain must be kept inside after liver operation.* Placing the omentum into cracks is not advised and don't do that.
Liver
Spleen
Kidney
Pancreas
Liver