Trauma Abdomen

Biasanya multitrauma

Penyebab
Trauma tumpul : falls, motorcycle or bicycle crashes,

sporting mishaps, and assaults. Compression causing a crush injury Shearing force causing tears of organs or vascular pedicles Sudden rise in intraabdominal pressure causing rupture of an intraabdominal viscus (Trauma Manual, 3rd edition) Trauma tembus -. Luka tembak -. Luka tusuk /impalement

Akibatnya
Syok hipovolemik

Shock should be regarded as present if any trauma patient presents with a systolic blood pressure less than 110 mmHg and a heart rate greater than 100 beats/min (Acute Care Surgery 2009)
Peritonitis

Abdominal examination after blunt trauma is often unreliable due to altered level of consciousness, spinal cord or other distracting injury, and medication or substance effects. (Trauma Manual, 3rd edition)

Resuscitation of Trauma patient

Resusitasi cairan pada anak

Bolus kristaloid I : 20 cc/kgbb
Bolus kristaloid II :20cc/kgbb Transfusi PRC/O negatif + FFP + trombosit

Bahaya hipotermi : cairan hangat, selimut hangat,

ruangan hangat Sering terjadi distensi lambung selama resusitasi pasang NGT

FAST

FAST

CT abdomen

Diagnostic Peritoneal Lavage

Criteria

for positive DPL 10 mL gross blood on aspiration > 100,000 red blood cells/mm3 >500 white blood cells/mm3 Bacteria. Bile Food particles

Trauma limpa

Trauma ginjal

Trauma usus
Gaster : debridement dan suture primer Usus halus :reseksi anastomosis, stoma Usus besar :
primary repair if minimal fecal spillage, no shock (defined as systolic blood pressure <90 mmHg), minimal associated intraabdominal injuries, <8-hour delay in diagnosis and treatment, and <1-L blood loss.

Rectum :

intraperitoneal : primary repair extraperitoneal : colostomy

TRAUMA ABDOMEN ANAK

Sering : trauma yeyunum, ileum, gaster
Trauma limpa : baik dikelola secara non operatif

Bila dilakukan splenectomy imunisasi post op (pneumococ, h.influenzae, meningococ) Trauma ginjal : sering

 Trauma hepar, lien, renal dikelola secara non operatif.

Pembedahan jika diperlukan darah s.d volume darah/24jam (40ml/kgbb)

Nonoperative management of blunt hepatic injury

Trauma, 2008, Feliciano

Damage control surgery laparotomy

The damage control sequence is commonly employed

to avoid the lethal triad of hypothermia (defined as a core body temperature of <35C), coagulopathy, and acidosis.

Three Step
1. Operating Room (Part I) Rapid control of hemorrhage Control or containment of contamination Restoration of vascular flow when required Intra-abdominal packing Temporary abdominal closure

2. Intensive Care Unit Core rewarming Optimization of hemodynamics Correction of coagulopathy Ventilatory support Secondary survey and injury identification

3. Operating Room (Part II) Pack removal Definitive repair of injuries Abdominal wall closure