Abdominal and Pelvic Injuries

by Kevin Pei, MD

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    00:01 Thank you for joining me on this discussion of abdominal and pelvic injury in the section of trauma.

    00:07 As a reminder, trauma is a very high-yield topic on USMLE exam questions and typically the questions always end in, “What’s your next step in management?” So I hope you’re paying close attention to this series.

    00:21 Let’s start with a clinical scenario.

    00:23 A 24-year-old man is driving 90 miles per hour and crosses the highway median.

    00:29 He sustains a head-on collision with oncoming traffic.

    00:33 At the scene, he’s reported to be unresponsive and EMS brings him to your trauma bay.

    00:40 In the trauma bay, he does not open his eyes at all and he’s already been intubated by the EMS.

    00:46 But motor wise, he does localize the pain.

    00:51 We’ll come back to this in a second.

    00:54 Here’s what the car looked at at the scene.

    00:56 And whenever you get a scenario and an image, you want to start thinking in your mind already what are possible injuries based on the mechanism of accident, what might be high-yield in terms of injuries in that list.

    01:11 Then you can use that to prepare for -- to answer for the actual question.

    01:17 Now just a quick question for you, what are your management priorities just like every other trauma patient? That’s right. Of course, airway, breathing, and circulation.

    01:29 Now it’s important in high-yield to just review the Glasgow Coma Scale quickly.

    01:34 Glasgow Coma Scale is included in a separate lecture module.

    01:39 But here, let’s remind you the patient’s finding and you decide what the patient’s GCS is.

    01:44 Remember, the patient did not have any eye opening, is intubated already, but he localizes the pain.

    01:52 I’ll give you a second to calculate the GCS.

    01:58 That’s right.

    01:58 The answer is E1V1T, remember, because the patient is intubated, and M is 5 for localization.

    02:08 Make sure you look over the traumatic brain injury information on Glasgow Coma Scale as a review.

    02:16 Now, let’s get back to our patient.

    02:18 This patient probably had prolonged extrication, again was unresponsive, so you know the mechanism is very, very high velocity.

    02:27 We don’t know if the patient was intoxicated, which may also be contributing to the patient’s mental status changes.

    02:35 Now, let’s say the patient has arrived in the emergency department, in the trauma bay, is already intubated.

    02:41 You’ve confirmed that the ET tube is in the correct position by end-tidal CO2.

    02:47 You listen to breath sounds and they’re present bilaterally and you move on to see and here the trauma bay nurses tell you the blood pressure is 80/60, clearly hypotensive.

    02:58 What’s going on with this patient? Remember, any hypotensive patient in trauma is presumed to be bleeding until proven otherwise.

    03:09 Now, what are some sites of possible bleeding? It’s a favorite question on your surgical rotations.

    03:16 Let’s take a quick look.

    03:18 First, the thorax.

    03:20 Each hemithorax can take liters of blood and clearly a source of major bleeding and potential source of the hypotension.

    03:29 Next, extremities whether it’s upper or lower extremity particularly the upper thighs which can contain liters of blood as well.

    03:36 Here, it may be easier to diagnose because you’ll look for asymmetry or asymmetry rather in the extremities.

    03:43 Pelvic fractures can cause significant bleed.

    03:46 Again, it can hold a fair amount of blood in the retroperitoneum.

    03:50 And of course, the abdomen.

    03:52 Lots of hemorrhage happens in the abdomen which has causes hypotension and may not demonstrate itself as abdominal distention.

    04:01 And don’t forget, large scalp lacerations or any major laceration that bled a significant amount particularly in the field may not be accounted for in your hypotension.

    04:12 Regardless, today we’re going to focus mostly on pelvic fractures and the abdominal portions.

    04:20 Other system injuries are covered under separate lecture modules.

    About the Lecture

    The lecture Abdominal and Pelvic Injuries by Kevin Pei, MD is from the course Surgery: Trauma.

    Included Quiz Questions

    1. 7T
    2. 4T
    3. 6T
    4. 5T
    5. 8T
    1. Airway, breathing, circulation
    2. CT brain
    3. Take GCS score
    4. Stop the bleeding
    5. Check for fractures

    Author of lecture Abdominal and Pelvic Injuries

     Kevin Pei, MD

    Kevin Pei, MD

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