Quantitative Peritoneal Lavage in Blunt Abdominal Trauma

Olsen, William R.; Redman, Helen C.; Hildreth, Douglas H.

doi:10.1001/archsurg.1972.04180040150026

Cited by 95 publications

(13 citation statements)

References 10 publications

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“…Data from the current study suggest that spirometric volume assessment may be more reliable for detecting torso injuries. Others have shown that physical examination has a modest sensitivity for detecting abdominal injuries (60–87%) [60-62]. The above literature suggests that an objective appraisal for torso injury may be needed to complement the physical exam.…”

Section: Discussionmentioning

confidence: 99%

Emergency department spirometric volume and base deficit delineate risk for torso injury in stable patients

Dunham

Sipe²,

Peluso

2004

BMC Surg

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BackgroundWe sought to determine torso injury rates and sensitivities associated with fluid-positive abdominal ultrasound, metabolic acidosis (increased base deficit and lactate), and impaired pulmonary physiology (decreased spirometric volume and PaO2/FiO2).MethodsLevel I trauma center prospective pilot and post-pilot study (2000–2001) of stable patients. Increased base deficit was < 0.0 in ethanol-negative and ≤ -3.0 in ethanol-positive patients. Increased lactate was > 2.5 mmol/L in ethanol-negative and ≥ 3.0 mmol/L in ethanol-positive patients. Decreased PaO2/FiO2 was < 350 and decreased spirometric volume was < 1.8 L.ResultsOf 215 patients, 66 (30.7%) had a torso injury (abdominal/pelvic injury n = 35 and/or thoracic injury n = 43). Glasgow Coma Scale score was 14.8 ± 0.5 (13–15). Torso injury rates and sensitivities were: abdominal ultrasound negative and normal base deficit, lactate, PaO2/FiO2, and spirometric volume – 0.0% & 0.0%; normal base deficit and normal spirometric volume – 4.2% & 4.5%; chest/abdominal soft tissue injury – 37.8% & 47.0%; increased lactate – 39.7% & 47.0%; increased base deficit – 41.3% & 75.8%; increased base deficit and/or decreased spirometric volume – 43.8% & 95.5%; decreased PaO2/FiO2 – 48.9% & 33.3%; positive abdominal ultrasound – 62.5% & 7.6%; decreased spirometric volume – 73.4% & 71.2%; increased base deficit and decreased spirometric volume – 82.9% & 51.5%.ConclusionsTrauma patients with normal base deficit and spirometric volume are unlikely to have a torso injury. Patients with increased base deficit or lactate, decreased spirometric volume, decreased PaO2/FiO2, or positive FAST have substantial risk for torso injury. Increased base deficit and/or decreased spirometric volume are highly sensitive for torso injury. Base deficit and spirometric volume values are readily available and increase or decrease the suspicion for torso injury.

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Section: Discussionmentioning

confidence: 99%

Emergency department spirometric volume and base deficit delineate risk for torso injury in stable patients

Dunham

Sipe²,

Peluso

2004

BMC Surg

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“…If peritoneal lavage does not identify blood, and if visceral angiograms or spleen scans or both are normal, late sequelae of splenic injury are extremely unlikely and prolonged evaluation unwarranted. 3. We are inclined to believe that our past concern for the late bleeding potential of small intrasplenic and capsular injuries has been greater than is justified.…”

Section: Commentmentioning

confidence: 99%

A Second Look at Delayed Splenic Rupture

Olsen

Polley²

1977

Arch Surg

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“…Positive DPL led to a rate of almost 30% non-therapeutic, unnecessary laparotomies. [534] Widely available CT scans and the introduction of FAST have generally replaced the invasive DPL. However, the Advanced Trauma Life Support course (ATLS) still includes this modality and it remains one of the skills that physicians need to learn for ATLS certification.…”

Section: Diagnosismentioning

confidence: 99%

“…[4] Since 1965, the introduction of diagnostic peritoneal lavage (DPL) has led to many nontherapeutic laparotomies in previously unsuspected low-grade injuries. [5] Operative intervention in high-grade injuries may result in high mortality as well. [46] Introduction of computed tomography (CT) scan, use of ultrasonography in trauma, availability of angiography, enhanced critical care monitoring and damage control surgery have revolutionized the management of liver trauma.…”

Section: Introductionmentioning

confidence: 99%

Management of liver trauma in adults

Ahmed

Vernick

2011

J Emerg Trauma Shock

103

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The liver is one of the most commonly injured organs in abdominal trauma. Recent advancements in imaging studies and enhanced critical care monitoring strategies have shifted the paradigm for the management of liver injuries. Nonoperative management of both low- and high-grade injuries can be successful in hemodynamically stable patients. Direct suture ligation of bleeding parenchymal vessels, total vascular isolation with repair of venous injuries, and the advent of damage control surgery have all improved outcomes in the hemodynamically unstable patient population. Anatomical resection of the liver and use of atriocaval shunt are rarely indicated.

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Quantitative Peritoneal Lavage in Blunt Abdominal Trauma

Cited by 95 publications

References 10 publications

Emergency department spirometric volume and base deficit delineate risk for torso injury in stable patients

Emergency department spirometric volume and base deficit delineate risk for torso injury in stable patients

A Second Look at Delayed Splenic Rupture

Management of liver trauma in adults

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