Trauma-- Blunt vs Penetrating Abdominal Wounds

[ForeverandEver]

I've been a little confused so wanted to clarify. Is the following correct?

Blunt abdominal trauma
--> everyone gets a FAST (and subsequent DPL if FAST is equivocal)---> if positive, do ex-lap. if neg and stable, can do CT.

Penetrating abdominal trauma
--> if hemodynamically unstable, do ex-lap (no FAST I guess?)
--> if hemodynamically stable, can observe or do local wound exploration

and of course, all GSW--> immediate ex-lap (no FAST I guess?)


Is that correct? I'm a little confused about blunt vs penetrating trauma as well as when to do a FAST. On my trauma rotation, if Iremember correctly, everyone got a FAST, whether blunt or stab wound.

Thanks!

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[turkeyjerky]

I've been a little confused so wanted to clarify. Is the following correct?

Blunt abdominal trauma
--> everyone gets a FAST (and subsequent DPL if FAST is equivocal)---> if positive, do ex-lap. if neg and stable, can do CT.

Penetrating abdominal trauma
--> if hemodynamically unstable, do ex-lap (no FAST I guess?)
--> if hemodynamically stable, can observe or do local wound exploration

and of course, all GSW--> immediate ex-lap (no FAST I guess?)


Is that correct? I'm a little confused about blunt vs penetrating trauma as well as when to do a FAST. On my trauma rotation, if Iremember correctly, everyone got a FAST, whether blunt or stab wound.

Thanks!

So, in modern practice, FAST exams are done pretty routinely on trauma patients. This does have merit, but a lot of it is really a teaching thing too. The real indication for a FAST is in an unstable patient: if positive -->OR, if negative look other places than the abdomen (pelvis, femurs, floor). On the other stuff, I think you're pretty good.

 

[ForeverandEver]

So you don't do FAST on stable patients for the purposes of test-taking?

So, revised, is the revised below version correct? Thanks in advance!

Blunt abdominal trauma
--> unstable: FAST (and subsequent DPL if FAST is equivocal)---> if positive, do ex-lap.
--> stable, do CT.


Penetrating abdominal trauma
--> if hemodynamically unstable, FAST (and subsequent DPL if FAST is equivocal)---> if positive, do ex-lap
--> if hemodynamically stable, can observe or do local wound exploration

and of course, all GSW--> immediate ex-lap

 

[turkeyjerky]

yeah, I think that's fine. Although I think you could prolly just take an unstable stab wound to the OR.