Confused about indications for DPL (Diagnostic Peritoneal Lavage)

[splapchole]

I read that MC indications for DPL were

1. to check the abdominal contribution to a hypotensive patient who does not respond to fluids...and

2. evaulate for hollow organ injury

Is this true for blunt and penetrating trauma?

I thought DPL is only used for blunt trauma patients.

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[blue2000]

Indications for DPL:

Blunt trauma:
1) hypotensive patient unable to be taken to scanner due to hemodynamic instability (this is also the indication for FAST, and many places have replaced DPL with FAST)
2) evaluate for hollow viscous injury (especially in setting of free fluid without solid organ injury...though I would say if you have FF without solid organ injury, you should got to OR)

Penetrating trauma
1) Some advocate DPL for evaluation of hemodynamically stable stab wounds, but I hate the idea. If you're that suspicious, I think you should do laparoscopy.

In my mind, there is no role for DPL in GSWs to the abdomen. They all belong in OR.

 

[SLUser11]

I read that MC indications for DPL were

1. to check the abdominal contribution to a hypotensive patient who does not respond to fluids...and

2. evaulate for hollow organ injury

Is this true for blunt and penetrating trauma?

I thought DPL is only used for blunt trauma patients.

DPL has very few modern-day indications in the big trauma center, but there are plenty of small-town and rural facilities that don't have ultrasound, where DPL is the least-invasive way of detecting hemorrhage or visceral perforation in the trauma bay.

The problem I have is that CT can detect hemorrhage in the stable patient, and unstable patients with significant abdominal trauma probably need a laparotomy, so the true utility of DPL is limited.

As for penetrating trauma, GSWs to the anterior abdomen are still a mandatory lap for me. Tangential wounds that go through and through a fat dude's pannus are the exception. Some other situations, such as a GSW to the right thoracoabdominal region, may have alternative tx such as conservative tx or laparoscopy to eval for diaphragm injury...but that's controversial.

Stab wounds are very controversial, and people like LD Britt will observe any patients that don't have peritoneal signs. What I can say for sure is that a mandatory laparotomy is historic, as the false negative rate is too high.

This conversation can go on forever, so I'll end it here. This topic is too broad.....

 

[JackADeli]

...LD Britt.....

worked me over on the certifying exam

 

[Winged Scapula]

worked me over on the certifying exam

Me too.

(not very funny part about it - my ex told me a couple of days before, "hope you don't get LD Britt" and proceeds to tell me scary things about him. Guess who I see on my list of examiners in the briefing room.)

 

[blue2000]

Someone from my program got worked over by LD Britt last year! I guess it should make everyone feel better that he's just that way, rather than he's so horrified by your answers it causes him to behave in startling ways.

 

[opr8n]

Someone from my program got worked over by LD Britt last year! I guess it should make everyone feel better that he's just that way, rather than he's so horrified by your answers it causes him to behave in startling ways.

try having him as mentor and teacher on a regular basis
he is like a book of knowledge and a personality to go with it
if you knew him he would be less intimidating

 

[Winged Scapula]

try having him as mentor and teacher on a regular basis
he is like a book of knowledge and a personality to go with it

He has the personality of a book?

if you knew him he would be less intimidating

Well interestingly enough, despite being "worked over" by him, I passed his room. So it may be true, as they tell you in the briefing room, that those who are the hardest on you may be the easiest evaluators.

 

[JackADeli]

...being "worked over" by him, ...those who are the hardest on you may be the easiest evaluators.

A colleague I spoke with said LD Brit encouraged her to relax, get comfortable, offered her a cigarette.... then as she was politely declining and trying to get over the bit of surprise.... Bamm! He yelled and shouted at her about the lady that caught fire smoking in bed!!!!

 

[opr8n]

A colleague I spoke with said LD Brit encouraged her to relax, get comfortable, offered her a cigarette.... then as she was politely declining and trying to get over the bit of surprise.... Bamm! He yelled and shouted at her about the lady that caught fire smoking in bed!!!!

highly doubtful
but i can see the situation in my mind right now and am lol b/c he is totally kidding when he does that, thats just the way he is

 

[JackADeli]

highly doubtful
but i can see the situation in my mind right now...

Very likely, she is very reliable and I have heard similar tales from others.

 

[SLUser11]

try having him as mentor and teacher on a regular basis
he is like a book of knowledge and a personality to go with it
if you knew him he would be less intimidating

What do you think about the acute care surgery model as it's practiced there? Does it seem to work pretty well?

 

[Winged Scapula]

A colleague I spoke with said LD Brit encouraged her to relax, get comfortable, offered her a cigarette.... then as she was politely declining and trying to get over the bit of surprise.... Bamm! He yelled and shouted at her about the lady that caught fire smoking in bed!!!!

Ha ha...

my room was totally different. It was noon in sunny Texas. Every other room was bright and airy with the examiners sitting in comfy chairs.

I walked into his room and the blackout curtains were drawn with only 1 table lamp on; it was dark and foreboding. It could have been winter or fall, 900 am or 900 pm. He sat at the desk with his feet on the table, glowering at me. Intimidating to say the least. No yelling but a few, "is that REALLY how you would manage your patient Doctor?" comments.

 

[Ronin2258]

Ha ha...

my room was totally different. It was noon in sunny Texas. Every other room was bright and airy with the examiners sitting in comfy chairs.

I walked into his room and the blackout curtains were drawn with only 1 table lamp on; it was dark and foreboding. It could have been winter or fall, 900 am or 900 pm. He sat at the desk with his feet on the table, glowering at me. Intimidating to say the least. No yelling but a few, "is that REALLY how you would manage your patient Doctor?" comments.

You didn't hear Bach's Toccata and Fugue start playing in the background when you entered that room, did you?

 

[opr8n]

, "is that REALLY how you would manage your patient Doctor?" comments.

he does that to everybody, he just wants you to stand your ground

 

[opr8n]

What do you think about the acute care surgery model as it's practiced there? Does it seem to work pretty well?

yes

 

[JackADeli]

What do you think about the acute care surgery model as it's practiced there? Does it seem to work pretty well?

yes

I suspect it is like many other ~unique and exciting systems/programs out there. Probably, looks good on paper and reports really nicely. But, it requires a significant buy-in from the powers that be. The question is how much "juice" does one need to import it to their local area? Many of these programs are supported and maintained on the foundation of just a few individual but very powerful figures with alot of clout.

 

[Winged Scapula]

he does that to everybody, he just wants you to stand your ground

Yeah, I figured as much.

 

[opr8n]

I suspect it is like many other ~unique and exciting systems/programs out there. Probably, looks good on paper and reports really nicely. But, it requires a significant buy-in from the powers that be. The question is how much "juice" does one need to import it to their local area? Many of these programs are supported and maintained on the foundation of just a few individual but very powerful figures with alot of clout.

the acute care surgery model is starting to take over at alot places. It obviously takes the trauma attendings who want to more gen surg and the hospital buy in that all emerg gen surg unattached pts will get sent to that service, and it can be run with the same residents, maybe needing one or two more. Its kinda nice to be doing some gen surg of a trauma rotation which is >90% nonoperative