Critical thinking unit 2 revision notes

But it is a framework rather than a detailed plan. This means that while every school curriculum must be clearly aligned with the intent of this document, schools have considerable flexibility when determining the detail.

Critical thinking unit 2 revision notes

Injury grading using the American Association for the Surgery of Trauma grading scale is a key component of nonoperative management of solid organ injuries.

Critical thinking unit 2 revision notes

Additional findings that should be noted on CT scan in patients with solid organ injury include contrast extravasation i. CT also is indicated for hemodynamically stable patients for whom the physical examination is unreliable.

Despite the increasing diagnostic accuracy of multislice CT scanners, CT still has limited sensitivity for identification of intestinal injuries. Bowel injury is suggested by findings of thickened bowel wall, "streaking" in the mesentery, free fluid without associated solid organ injury, or free intraperitoneal air.

Penetrating abdominal wounds are usually caused by either gunshot or stab wounds and by a significantly smaller number of shotgun wounds. Based on the high frequency of intra-abdominal organ injury after gunshot wounds, mandatory abdominal exploration, with the rare exception of tangential and superficial wound trajectories restricted to the right upper quadrant, remains the standard form of management.

Stab wounds to the abdomen, however, carry a significantly lower risk of intra-abdominal organ injury than do gunshot wounds, and several studies have recently favored a more selective approach, as opposed to mandatory exploratory laparotomy.

The impetus for nonoperative management of solid organ injury in stable blunt trauma patients has expanded to penetrating trauma as well. With improved imaging, more stable patients sustaining a single solid organ injury after stab and gunshot wounds to the abdomen will be treated conservatively.

The diagnostic approach differs for penetrating trauma and blunt abdominal trauma. In contrast to gunshot wounds, stab wounds that penetrate the peritoneal cavity are less likely to injure intra-abdominal organs. In such instances, DPL or focused abdominal sonography for trauma FAST is usually performed in the operating room to rule out intra-abdominal bleeding requiring immediate surgical exploration.

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Hemodynamically stable blunt trauma patients are evaluated by ultrasound in the resuscitation room, if available, or by DPL to rule out intra-abdominal injuries as the source of blood loss and hypotension.

Hypotensive patients with isolated penetrating abdominal trauma who are hypotensive or in shock or have peritoneal signs should go to the operating room despite the mechanism of injury.

Stab wound victims without peritoneal signs, evisceration, or hypotension benefit from wound exploration and DPL. Gunshot wound victims should generally undergo exploration MC abdominal organ injured in blunt trauma abdomen is — PGI 99 a Spleen b Liver c Pancreas d Stomach The spleen is the intra-abdominal organ most frequently injured in blunt trauma.

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Suspicion of a splenic injury should be raised in any patient with blunt abdominal trauma. History of a blow, fall, or sports-related injury to the left side of the chest, flank, or left upper part of the abdomen is usually associated with splenic injury. The diagnosis is confirmed by abdominal CT in a hemodynamically stable patient or during exploratory laparotomy in an unstable patient with positive DPL findings.

The small bowel is the most frequently injured organ after penetrating injuries. The colon is the second most frequently injured organ after gunshot wounds and the third after stab wounds to the abdomen.

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The classic criteria for nonoperative treatment include hemodynamic stability, negative abdominal examination, absence of contrast extravasation on CT, absence of other clear indications for exploratory laparotomy or associated injuries requiring surgical intervention, absence of associated health conditions that carry an increased risk for bleeding coagulopathy, hepatic failure, use of anticoagulants, specific coagulation factor deficiencyand injury grade I to III.

Recent series have also indicated that nonoperative management should be performed in patients older than 55 years, those with a large hemoperitoneum, and patients with injury grades IV and V, which in the past have been relative contraindications.Epic Bio Notes (For A-level) Chemistry Questions.

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Critical thinking unit 2 revision notes

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Critical Thinking Unit 1 and 2 Revision Notes - Document in A Level and IB Critical Thinking