1m.a.kubtan. 2 what is torso : the body excluding the head and neck and limbs m.a.kubtan3
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What is TORSO :The body excluding the head and neck and
limbs
TORSO TRAUMA
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What is trauma ?
The medical problems associated with physical injury .
Injury is the adverse effect of physical force upon a person .
Forces that can lead to injury include : mechanical , thermal ,ionizing radiation , and chemical .
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The Troso is generally regarded as the area between the neck and the groin ,made up of the thorax and abdomen .
Division of the body into abdomen and thorax is artificial .
Injury to the troso is more appropriate. Our aim is restoration of normal
physiology . Accordingly trauma surgery requires
knowledge of anatomy and physiology .
Introduction
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Between the neck and the thorax . Between the thorax and the abdomen . Between the abdomen and the pelvic
structures and the groin .
This zones represent surgical challenges in terms of diagnosis of the area of injury and surgical approach .
It is related and balanced against the physiological stability of the patient .
Junctional zones
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Patients who have suffered abdominal injury can be generally classified into :
Haemodynamiclly normal . Haemodinamiclly stable . Haemodynamically unstable .
Abdominal Injury
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A B C D E of trauma care
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Cardiovascular status . Radiological imaging . Stable patient may be able to have CT
scan . Evaluation of torso trauma .
Investigation
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CT scan with intravenous contrast most valuable ( however in unstable patient it not always possible ) .
DPL Diagnostic peritoneal lavage . the presence of > 100 000 red cells /micro liter
or > 500 white cells in the peritoneal washout is an indication of intraperitoneal bleeding and this is equivalent to 20 ml of free blood in the abdominal cavity .
Drainage of peritoneal lavage fluids via chest drain is an indication of penetration of diaphragm .
Diagnostic tools
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When positive it means that there is free blood in the peritoneal cavity .
Negativity does not rule out the presence of blood in the peritoneal cavity .
4 quadrant tap
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FAST Focused abdominal sonar for trauma . FAST is a technique whereby US imaging is used
to assess the TORSO for the presence of blood . This technique focuses on four areas : Pericardial, Splenic , Hepatic , Pelvic .FAST is accurate for the detection of < 100 ml of
free blood in the peritoneom .It is extremely dependent on the operator
experience .
FAST
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FAST
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CT is the gold standered for the intra-abdominal diagnosis in the stable patient .
CT is performed using intravenous and often oral contrast as well .
CT has the advantages of sensitivity for the diagnosis of retroperitoneal injury .
CT is usually sufficient to exclude injury .
Computerized Tomography
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DL is valuable screening investigation in penetrating trauma .
DL of course in stable patient s following an abdominal or thoraco-abdominal stab wound .
DL is not appropriate for use in the unstable patient .
DL is difficult to exclude all intra-abdominal injuries laparoscopic ally .
DL is not a substitute for open laparatomy especially in the presence of haemoperitonium or contamination.
DL Diagnostic Laparoscopy
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Liver The majority of livers injuries occur as a result
of blunt injury which may burst liver . The use of CT for the evaluation of trauma
patient ( liver , spleen , kidneys ) . The liver is a solid organ and may be
compressed between the forces and the rib cage or vertebral column.
Penetrating trauma relatively common ( stab wound , bullets cause significant damage ).
Not all penetrating wounds require operative management.
Individual Organ Injury
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Push : direct compression . Pringle : The inflow from the portal triad
is controlled by pringle maneuver . Plug :any holes can be plugged directly . Pack .
Management of liver injury
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Occur mainly from penetrating trauma . Common bile duct injuries often associate
with portal vein injury .
Biliary injuries
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Splenic injury occurs from direct trauma , Overlaying ribs ( ninth to 11th ribs ) . Most isolated splenic injuries espacially in children can
be managed non operatively . In adults in the presence of other injuries laparatomy
may become indicated depending on physiological instability .
At laparatomy direct splenorrhaphy , or packed , repaired or placed in a mesh bag.
Selective embolisation of spleen can play a role . Following splenectomy : changes in blood
physiology ,raised platelets count > 1000000 , and white cell count rises and mimic sepsis.
Spleen
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Due to blunt trauma . CT scan the main test of value . Amylase may be low or normal ( low
amylase in 50% of cases .) . Treatment : conservative , closed suction
drainage , distal pancreatectomy , Wipple,s procedures .
Pancreas
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Renal and urological tract Injury
Major abdominal vessels Injury
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Stomach . Duodenum . Small bowel . Colon . Rectum.
hollow viscus
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