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.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Blunt chest injuries:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
A history of trauma with dyspnea, chest pain, and other typical clinical features suggest a blunt chest injury. To determine its extent, a physical examination and diagnostic tests are needed.
❑ In hemothorax, percussion reveals dullness. In tension pneumothorax, it reveals tympany. Auscultation may reveal a change in position of the loudest heart sound.
❑ Chest X-rays may confirm rib and sternal fractures, pneumothorax, flail chest, pulmonary contusions, lacerated or ruptured aorta, tension pneumothorax, diaphragmatic rupture, lung compression, or atelectasis with hemothorax.
❑ With cardiac damage, the ECG may show abnormalities, including unexplained tachycardias, atrial fibrillation, bundle-branch block (usually right), ST-segment changes, and ventricular arrhythmias such as multiple premature ventricular contractions.
❑ Serial aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, creatine kinase (CK), and CK-MB levels are elevated. However, cardiac enzymes fail to detect up to 50% of patients with myocardial damage.
❑ Retrograde aortography and transesophageal echocardiography reveal aortic laceration or rupture.
❑ Contrast studies and liver and spleen scans detect diaphragmatic rupture.
❑ Echocardiography, computed tomography scans, and cardiac and lung scans show the injury’s extent.
» READ BOOK EXCERPT ONLINE »
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.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Acceleration-deceleration cervical injuries:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Full cervical spine X-rays are required to rule out cervical fractures. If the X-rays are negative, the physical examination focuses on motor ability and sensation below the cervical spine to detect signs of nerve root compression.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Cold injuries:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
A history of severe and prolonged exposure to cold may make this diagnosis obvious. Nevertheless, hypothermia can be overlooked if outdoor temperatures are above freezing or if the patient is comatose.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Wounds, open trauma:
Diagnosis
(Handbook of Diseases)
A thorough physical examination of the patient will reveal traumatic wounds. They may be seen during the primary and secondary assessment of the patient.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Chest injuries, blunt:
Diagnosis
(Handbook of Diseases)
A history of trauma with dyspnea, chest pain, and other typical symptoms suggest a blunt chest injury. A physical examination and diagnostic tests determine the extent of injury.
❑ Percussion reveals dullness in hemothorax and tympany in tension pneumothorax.
❑ Auscultation may reveal a change in position of the loudest heart sound in tension pneumothorax or muffled heart tones in cardiac tamponade.
❑ Chest X-rays may be used to confirm rib and sternal fractures, pneumothorax, flail chest, pulmonary contusions, lacerated or ruptured aorta, tension pneumothorax, diaphragmatic rupture, lung compression, or atelectasis with hemothorax.
❑ ECG may show abnormalities with cardiac damage, including multiple premature ventricular contractions, unexplained tachycardias, atrial fibrillation, bundle-branch heart block (usually right), and ST-segment changes.
❑ Serial aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, creatine kinase (CK), and CK-MB levels are elevated.
❑ Retrograde aortography and transesophageal echocardiography reveal aortic laceration or rupture.
❑ Contrast studies and liver and spleen scans help detect diaphragmatic rupture.
❑ Echocardiography, computed tomography scans, and cardiac and lung scans show the extent of the injury.
» READ BOOK EXCERPT ONLINE »
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
Abdominal injuries:
Diagnosis
(Handbook of Diseases)
A history of abdominal trauma, signs and symptoms, and laboratory results confirm the diagnosis and help determine organ damage. Consider any upper abdominal injury a thoracicoabdominal injury until proven otherwise. Diagnostic studies vary with the patient’s condition but usually include:
chest X-rays (preferably done with the patient upright) to show free air
examination of stool and stomach aspirate for blood
blood studies (decreased hemoglobin levels and hematocrit point to severe blood loss; coagulation studies evaluate hemostasis; white blood cell count is usually elevated but doesn’t necessarily point to infection; typing and crossmatching help prepare for blood transfusion)
arterial blood gas analysis to evaluate respiratory status
serum amylase levels, which are commonly elevated in those with 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
angiography to detect specific injuries, especially to the kidneys
peritoneal lavage with insertion of a lavage catheter, to check for blood, urine, pus, ascitic fluid, bile, and chyle (a milky fluid absorbed by the intestinal lymph vessels during digestion) (In blunt trauma with equivocal abdominal findings, this procedure helps establish the need for exploratory surgery.)
computed tomography scan to detect abdominal, head, chest, or other injuries
exploratory laparotomy to detect specific injuries when other clinical evidence is incomplete
other laboratory studies to rule out associated injuries.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Cold injuries:
Diagnosis
(Handbook of Diseases)
A history of severe and prolonged exposure to cold may make this diagnosis obvious. Nevertheless, hypothermia can be overlooked if outdoor temperatures are above freezing or if the patient is comatose.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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