BLUNT ABDOMINAL TRAUMA(Surgery algorithm)

[muziklova220]

Hi Dr. Joseph - I just did a WORLD question about a RUQ gunshot wound of a hemodynamically unstable patient and the answer was to do an exploratory laparotomy. Have the recommendations changed recently or am I missing something? Thank you so much for your videos!! My test in in 15 days.

[josephmedman]

@muziklova220 Exploratory Laparotomy is always the correct answer in hemodynamically unstable patients if that choice is there. Many times the patient is hemodynamically STABLE in RUQ gun shot wounds, thats why you see in the algorithm I wrote serial abdominal exams MAY be used in RUQ gun shot wounds, but Ex Lap is never a bad option if they are unstable. Im SURE the question did not give serial abdominal exams and exploratory lap. in the same choices. Just be aware that option exists

[muziklova220]

@josephmedman Thanks so much!! Serial abdominal exams was not an option. I was just wondering why it wasn't based on what I'd learned here. But I definitely get it now! In unstable RUQ gun shot wound patients, look for serial abdominal exams as a choice. If it's not there, exploratory lap is the answer. Thanks!!

[drkaur80]

Hi Dr Joseph

Great work !

please could you summarize about antibiotics according to system wise. That would be great for step 3.

Thank u so much.

[molumee]

I was wondering if you have made an algorithm for anemias these are very helpful for step 3 thank you

[raimoris]

I had one case of pistol shot wound on the thigh then the bullet went thorough the abdominal wall, digital exploration performed sugested the bullet didn't cross thorough the parietal peritoneal layer and meanwhile the patient was stable. there was no CT available. what is your suggestion in this case ? thanks

[kripagoyal]

DrJoseph, what do we do if DPL is also negetive? CT?

Is there any time that we should directly go to laprotomy?Thanks a lot for the vid again.

[josephmedman]

if the dpl is negative and the patient is unstable you must do a laparotomy. There is no time for the CT if they have unstable vitals, you have to open them up to see what is going on..

[TheBrownBaron]

@josephmedman

I thought you would then do angiography if DPL is negative b/c then you're looking for a retroperitoneal bleed.

[jasonmalice]

@TheBrownBaron yes i thought angiography too if neg dpl/usg for retroperitoneal bleed, or is that only in pelvic fractures?

[natashakhan123]

hey i really appreciate you taking out time to do this.If possible can u do some topics from internal medicine esp cardio?u explain it really well n to the point.