CONFIRMING DIAGNOSIS A history of abdominal trauma, clinical features, and laboratory test results confirm the diagnosis of blunt or penetrating abdominal injury and determine organ damage.
Consider any upper abdominal injury a thoracicoabdominal injury until proven otherwise. Laboratory studies vary with the patient’s condition but usually include:
❑ chest X-rays (preferably done with the patient upright to show free air)
❑ abdominal X-rays
❑ examination of stools and stomach aspirate for blood
❑ blood studies (decreased hematocrit and hemoglobin levels point to blood loss; coagulation studies evaluate hemostasis; white blood cell count is usually elevated but doesn’t necessarily point to infection; type and crossmatch to prepare for a blood transfusion)
❑ arterial blood gas analysis to evaluate respiratory status
❑ serum amylase levels, which may be elevated in pancreatic injury
❑ aspartate aminotransferase and alanine aminotransferase levels, which increase with tissue injury and cell death
❑ excretory urography and cystourethrography to detect renal and urinary tract damage
❑ radioisotope scanning and ultrasound to detect liver, kidney, or spleen injury
❑ angiography to detect specific injuries, especially to the kidneys
❑ computed tomography scan to detect abdominal, head, or other injuries
❑ exploratory laparotomy to detect specific injuries when other clinical evidence is incomplete
❑ other laboratory studies to rule out associated injuries
❑ peritoneal lavage with insertion of a lavage catheter to check for blood, GI content, vegetable fibers, and bile. In blunt trauma with equivocal abdominal findings, this procedure helps establish the need for exploratory surgery.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Spinal injuries:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
The diagnosis is typically based on the patient’s history, physical examination, X-rays, computed tomography (CT) scan, and magnetic resonance imaging (MRI).
The patient history may reveal a traumatic injury, a metastatic lesion, an infection that could produce a spinal abscess, or an endocrine disorder. The physical examination (including a neurologic evaluation) locates the level of injury and detects cord damage.
Spinal X-rays, the most important diagnostic measure, locate the fracture. In spinal compression, a lumbar puncture may show increased cerebrospinal fluid pressure from a lesion or trauma; a CT scan or MRI can locate a spinal mass.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Battle's sign:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Perform a complete neurologic examination, beginning with the history. Ask the patient about recent trauma to the head. Did he sustain a severe blow to the head? Was he involved in a motor vehicle accident? Note the patient’s level of consciousness as he responds. Does he respond quickly or slowly? Are his answers appropriate, or does he appear confused?
Check the patient’s vital signs; be alert for widening pulse pressure and bradycardia, signs of increased intracranial pressure. Assess cranial nerve function in nerves II, III, IV, VI, VII, and VIII. Evaluate pupillary size and response to light as well as motor and verbal responses. Relate these data to the Glasgow Coma Scale. Also, note cerebrospinal fluid (CSF) leakage from the nose or ears. Ask about postnasal drip, which may reflect CSF drainage down the throat. Look for the halo sign—a bloodstain encircled by a yellowish ring—on bed linens or dressings. To confirm that drainage is CSF, test it with a Dextrostix; CSF is positive for glucose, whereas mucus isn’t. Follow up the neurologic examination with a complete physical examination to detect other injuries associated with a basilar skull fracture.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Amputation, traumatic:
Diagnosis
(Handbook of Diseases)
Any patient with a traumatic amputation requires careful monitoring of vital signs as well as assessment for other traumatic injuries. If amputation involves more than just a finger or a toe, assessment of airway, breathing, and circulation is also required. Because profuse bleeding is likely, watch for signs of hypovolemic shock, and draw blood for hemoglobin level, hematocrit, and typing and crossmatching. If the patient has a partial amputation, check for pulses distal to the amputation.
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Source: Handbook of Diseases, 2003
Spinal injuries:
Diagnosis
(Handbook of Diseases)
Typically, a diagnosis is based on the patient history, the physical examination, X-rays and, possibly, lumbar puncture, computed tomography (CT) scan, and magnetic resonance imaging (MRI).
❑ Patient history may reveal trauma, a metastatic lesion, an infection that could produce a spinal abscess, or an endocrine disorder.
❑ Physical examination (including a neurologic evaluation) locates the level of injury and detects cord damage.
❑ Spinal X-rays, the most important diagnostic measure, locate the fracture.
❑ Lumbar puncture may show increased cerebrospinal fluid pressure from a lesion or trauma in spinal compression.
❑ CT scan or MRI can locate the spinal mass.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Battle's sign:
History
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Obtain the patient’s history, noting recent trauma to the head such as involvement in a motor vehicle accident. Assess his level of consciousness and the appropriateness of his responses to your questions.
Physical examination
Perform a complete neurologic assessment. Check the patient’s vital signs; stay alert for widening pulse pressure and bradycardia — these are signs of increased intracranial pressure. Assess cranial nerve (CN) function in CN II, III, IV, VI, VII, and VIII. Evaluate pupillary size and response to light as well as motor and verbal responses. Relate these data to the Glasgow Coma Scale. Assess for cerebrospinal fluid (CSF) leakage from the nose or ears. Ask about postnasal drip, which may reflect CSF drainage down the throat. Look for the halo sign — a bloodstain encircled by a yellowish ring — on bed linens or dressings. Test drainage to determine the presence of CSF. Follow the neurologic examination with a complete physical examination to detect other injuries associated with a basilar skull fracture.
» READ BOOK EXCERPT ONLINE »
Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Battle's sign:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Ask the patient about recent trauma to the head. Did he sustain a severe blow to the head? Was he involved in a motor vehicle accident? Note the patient’s level of consciousness (LOC) as he responds. Does he respond quickly or slowly? Are his answers appropriate, or does he appear confused?
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Battle's sign:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Perform a complete neurologic examination. Begin with the history. Ask the patient about recent trauma to the head. Did he sustain a severe blow to the head? Was he involved in a motor vehicle accident? Note the patient's level of consciousness as he responds. Does he respond quickly or slowly? Are his answers appropriate, or does he appear confused?
Check the patient's vital signs; be alert for widening pulse pressure and bradycardia, signs of increased intracranial pressure. Assess cranial nerve function in nerves II, III, IV, VI, VII, and VIII. Evaluate pupillary size and response to light as well as motor and verbal responses. Relate these data to the Glasgow Coma Scale. Note cerebrospinal fluid (CSF) leakage from the nose or ears. Ask about postnasal drip, which may reflect CSF drainage down the throat. Look for the halo sign—bloodstain encircled by a yellowish ring—on bed linens or dressings. To confirm that drainage is CSF, test it with a Dextrostix; CSF is positive for glucose, whereas mucus isn't. Follow up the neurologic examination with a complete physical examination to detect other injuries associated with basilar skull fracture.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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